As Chief of Cardiology at Harlem Hospital Center, Dr. Fergus sees stress, poverty and discrimination as all playing an important part in the health of many urban communities particularly those of African Americans and Hispanic ethnicities. Her goal is to reach community members where they are at-either on the streets or in their heads. She told us her philosophy is to work with patients to fight heart disease as a team.
Q: What are some of the key cardiovascular issues facing African Americans' and Hispanics' health in Harlem?
A: African American and Hispanic communities have worse outcomes for high blood pressure , diabetes and obesity than other groups. They die younger and have more co morbidities . The reasons are tied to economic and mental stress issues as well as to the traditional risk factors such as family medical history. Many people have a hard time trusting medical professionals which can result in non-adherence with medications or health care plans. I find that my ability to speak fluent Spanish helps me to gain trust with my Hispanic patients. If I can't understand them, how can I treat them?
Q: Are there differences in the ways that men and women in Harlem can keep their hearts healthy?
A: For the most part, African American women who are middle-aged or older have a role as the family caretaker. They make sure everything runs as smoothly as possible for the family-and in the process they may neglect their own health. I see myself as an advocate. I tell them, "If you don't take care of yourself, you won't be there to take care of your loved ones."
It's also important for men and women alike to be aware of things like medication side effects, because this can play a big role in medication adherence. For instance, alopecia is a common side effect of ARB and ACE Inhibitors which are common drugs prescribed for high blood pressure. These drugs can often make women's hair fall out, or cause them to gain weight. As many women are sensitive to both of these things, it may be especially important to find an alternative drug if you want them to keep taking the medication. As a doctor, you also can't assume that weight gain is something that all women see as a bad thing. Some women may feel that it is better to have more body weight at middle age. I try to approach my treatment for each patient with cultural sensitivity and on an individual basis.
Q: What are the top things you would suggest for the Harlem community to prevent heart attacks?
A: Unfortunately some of the early warning signs or risk factors that signal a person is headed toward a heart attack may be silent-like high blood pressure, diabetes, and high cholesterol. Someone may not have symptoms until things are really bad. It is important that you get these things checked out by a medical professional starting at an early age before these diseases cause major damage to your organs.
It is also important for families to start thinking and learning about health at an earlier age. That is the way you prepare children to become healthy adults.
Q: If a person has already had a heart attack, what are some of the most important things they can do to regain their health?
A: They need to exercise. They need to get back to being as active as they can. This may mean a lifestyle change. It's like when your kitchen sink pipes get clogged. If you clean them out, you can't keep throwing chicken fat down there and not expect them to get clogged up again. The same thing applies to the body. You have to change your lifestyle or you'll have another heart attack.
People need to take their medications, not smoke and live an active life. And, it is important to get your family involved. You can't make these kinds of changes all on your own.
Q: Do you have a story to share about a "happy ending" about someone who succeeded in overcoming a health challenge?
A: I had a patient in her late 30s who was dying of heart failure while she was pregnant with her first child. She was very ill and the medical team thought both she and her baby would die. Caring for her at the hospital was a team effort. A healthy baby was delivered, and the patient slowly recovered to point now where she has a relatively normal life. She made a lot of changes in her life. We started with medications, counseling, guidance and support. She is now taking her medications regularly, coming to doctor visits, eating the right foods and exercising.