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By Laurie Kaye Abraham. pp. 289. Chicago: University of Chicago Press, 1993, $22.50.
Mama Might Be Better Off Dead is a powerful and revealing ethnography of one African American family and its struggle with the prevailing health care system in the United States. Author Laurie Kaye Abraham, in the role of an objective observer, provides a gripping account of four generations of the Baneses, an impoverished urban Chicago family, as they survive multiple medical catastrophies. Somehow, though, they always seem to make it to the next day Mama Might Be Better Off Dead also reveals how government health care policies function when they "hit the streets."
The book follows the Banes family for one year, chronicling the family's experiences through home and community life, dialysis counseling and treatment, hospital visits, and doctors' appointments. The author guides the reader through a myriad of complex medical issues that confront some of America's poor on a daily basis. Each chapter describes in detail yet another medical-social scenario in which the Baneses are forced to adjust to their dismal plight. Abraham also vigorously reports on the racial inequalities and politics of substandard living conditions, dialysis treatment, government insurance, patient and caregiver issues, mental health issues, inner-city emergency room care, personal responsibility, preventive care, organ donation and transplantation, interaction with medical professionals, right to life, quality-of-life issues, and how treating the poor is "bad" for business. Embedded within each of these issues, however, is a complex array of other aspects facing the Baneses, including the administration of social services, employment, intergenerational issues, transportation, long-term care, and, to a lesser extent, family and personal relationships.
The Baneses live in North Lawndale, one of Chicago's poorest inner-city (a term that is often a euphemism for areas inhabited primarily by poor blacks) neighborhoods. Only 8 percent of the neighborhood's 8,937 buildings are habitable. The rest are abandoned, on the verge of collapse, or in need of repair. North Lawndale is a community surrounded by numerous medical facilities, including urban and university hospitals, private medical complexes, the Veterans Administration Medical Center, clinics, dialysis centers, mental health facilities, and social service offices. The VA center has the highest concentration of hospital beds in the United States, some 3,000 among its four institutions. But while this...