Pulse
A Shave, a Haircut—and a Kidney?
Barbers teach African-American men about organ donation and the importance of attending to their own health.
By Trout Lowen
The body is a lot like a vehicle, Mr. B likes to tell customers while he clips, snips, and trims their curly locks into the latest fade, shade, or flat top.
In between talk of the Twins, Vikings, and Timberwolves, Mr. B, also known as Bilal Saleem, a master barber at the Gifted Handz salon in St. Paul, talks about his own efforts to take better care of himself and the reasons his clients should, too.
The Need for African-American Donors
In Minnesota and across the country, African-American men have lower organ and tissue donation rates than the majority population and lower rates than African-American women.
Overall, about 55 percent of Minnesotans have an organ-donor designation on their driver’s license. Women have the highest rate, around 55 percent. The average rate for men is about 45 percent. The rate for African-American men is closer to 35 percent, according to David Radosevich, Ph.D., an epidemiologist and assistant professor in the University of Minnesota’s department of surgery.
At the same time, African- Americans are disproportionally represented on the transplant waiting list. In Minnesota, African-Americans make up about 8 percent of the state’s population but represent closer to 16 percent of the patients waiting for a transplant, Radosevich says. That is because they also have higher rates of the diseases that can lead to organ failure such as diabetes and hypertension. Nationwide and in Minnesota, African-Americans are five times more likely than whites to develop end-stage renal disease and require a kidney transplant.
Of the 362 men who took part in the Barbershop Conversations project, an effort to increase the number of African-American men who are organ donors, 55 percent had at least one of the antecedent risk factors for renal disease: hypertension, diabetes, or a body mass index of 30 or above. Radosevich called that finding “alarming,” given that the average age of the participants was around 40.
“That’s a very high percentage with a pre-existing health condition that would predispose them to kidney problems down the road,” he says.—T.L.
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“Your car, if you don’t have gas in it, then it’s not going anywhere,” he says. “If you don’t check to see if your battery is up to par, then it’s not going to last long. And if you don’t have the right amount of oil in it, your engine can blow up.”
Although his analogy may seem a little unorthodox, Mr. B’s folksy wisdom about good health is something his clients—African-American men—can relate to. And it’s something many of them need to hear. “I’ve had battles of my own, and I see the needs of others in the African-American community,” Saleem says. “Information [about healthy living] is out there, but it’s not really at the level where it needs to be.”
That’s one of the reasons Saleem agreed to participate in Barbershop Conversations, a three-year initiative to improve health and increase the number of African-American men in the Twin Cities who are organ donors. The project, jointly sponsored by LifeSource, the University of Minnesota, and Q Health Services, has involved 26 barbers at 18 barbershops in Minneapolis, St. Paul, and the Twin Cities suburbs. Modeled after similar initiatives around the country, it initially focused on using barbers to provide culturally specific, community-based education about organ donation. The barbers now also provide information about diabetes, hypertension, and obesity.
As a group, African-Americans have higher rates of these conditions, which contribute to kidney failure, than the general population and lower organ donor rates—about 10 percent lower than the majority population, explains Susan Mau Larson, public relations director for LifeSource, which coordinates organ and tissue donation in the Upper Midwest. African-Americans also make up a disproportionately high percentage of those on the transplant waiting list (see “The Need for African-American Donors”).
It’s a difficult population to reach through traditional public health channels, however. Many African-American men don’t visit the doctor regularly, and many distrust the medical community. Barbershops are gathering places where very open and honest conversations often take place, Larson says. Saleem agrees. He’s known some of his clients for nearly 20 years. They come in for a haircut and stay for coffee and conversation.
The barbers who participated in the project were taught how to engage clients in ongoing discussions about health and ultimately about organ donation. And they were paid for their participation and for each donor recruited. A total of 362 men participated in the project; their average age was 40 years.
A Question of Trust
From the outset, one of the project organizers’ biggest challenges was building trust, both with the barbers and their clients, says David Radosevich, Ph.D., an epidemiologist and assistant professor in the University of Minnesota’s department of surgery and the lead researcher on the project.
Radosevich says when he first walked into the barbershops, some of the owners suspected he might be “po po” (slang for police), and one thought he was trying to collect alimony. There was also mistrust of the project, he says. Often, one of the first issues to come up in conversation was the Tuskegee syphilis study, conducted by the U.S. Public Health Service between 1932 and 1972. Many of the early discussions with the barbers, he says, were about convincing them that the university wasn’t recruiting for an experiment. Clarence Jones, director of Q Health Services, the outreach arm of Southside Community Health Services, says the researchers had to earn the barbers’ trust. “We had to spend a lot of time up front being transparent, being open, and answering questions,” he says.
Radosevich says they also had to dispel misconceptions about organ donation. Many participants were concerned that as organ donors they might receive substandard medical care in an emergency. That isn’t just a concern among African-Americans, however, Radosevich says. He’s heard the same concern expressed by his 30-year-old son. Others were convinced that organs donated by African-Americans would likely go to white patients. He says the opposite scenario is more likely because there are proportionately more African-Americans on the transplant waiting list and because certain antigenic alleles are more common within certain racial groups, which makes a black-to-black or white-to-white match slightly more likely.
Although many of the participating barbers had experience with transplantation through a family member—one was even planning to be a living kidney donor for his sister, broaching the topic of organ donation was still difficult. “What we ended up doing was focusing the early part of our intervention on questions about chronic disease that are more salient in the black community,” Radosevich says.
The Results
Preliminary findings show only a small increase in the rate of organ donation. But the $350,000 project, funded by a grant from the U.S. Health Resource and Service Administration and supported by the Pan African Community Endowment of the St. Paul Foundation, is still being viewed as a success.
Participants were asked to fill out a survey at the beginning and end of the project to assess their views of organ donation. At the end of three years, both barbers and clients were more willing to consider donation, were more informed about donation, and were more willing to talk about donation with friends and family. They were also better informed about the risk factors for chronic disease and lifestyle changes that could improve their health. “You didn’t see a huge change in terms of the numbers according to the state registry because most of the people change their choice when they get their [driver’s] license renewed. But we definitely have story narratives and other kinds of indicators that say that attitudes of people have changed,” Jones says. “That’s all you want.”