Amanda McCoy, MD, MPH, is an orthopaedic surgeon at UPMC Children’s Hospital of Pittsburgh and assistant professor in the Division of Pediatric Orthopaedics at the University of Pittsburgh School of Medicine. Dr. McCoy earned her medical degree at Duke University School of Medicine while completing a master of public health degree from the University of North Carolina Gillings School of Global Public Health. She returned to her undergraduate alma mater for the Harvard Combined Orthopaedic Residency Program, followed by a pediatric orthopaedic surgery fellowship at Baylor College of Medicine in Texas.
Before joining UPMC in fall 2021, you spent three years at Tenwek Hospital, a teaching and referral mission hospital in Bomet, Kenya, where you worked throughout the pandemic. What led you there?
When I was in high school, I heard a missionary speak at our church about his medical ministry in Gabon. I didn’t know I would become a doctor, but his words stuck with me. Then, as a fourth-year resident, I found myself asking, “Okay, what am I actually going to do with my life?” Fortunately, I was able to spend two months at Tenwek Hospital for my elective as a fifth-year resident. After I finished my fellowship, I originally committed there for two years. But I extended my time in Kenya to three years to help transition the leadership of the residency program.
What was it like to practice medicine in Kenya?
Moving to a different country and learning a different language in my early 30s was admittedly a lot to unpack! But I really felt passionate about the opportunity I had to help build a quality orthopaedic surgery residence program there.
I was interim program director of the residency, doing didactics, bedside training, and technical skill-building in the operating room. It was a wonderful experience where I developed some of my most meaningful relationships.
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Some of the things I saw in Kenya were very hard to watch. Children died in the operating room due to inadequate medicines and supplies. Friends of mine, both doctors, lost their child to diarrheal illness. I recognize that even here in the United States resources are unevenly distributed — let alone around the world — but there were times when the reality of all that was hard to reconcile. I learned that global health and local health are truly interconnected.
How did Kenya’s medical community respond to COVID?
At the onset of the pandemic, I was concerned for my family back home and for my own safety. And I especially worried about my residents, some of whom had baseline respiratory illnesses.
But as time progressed, it was interesting to see how hard it was to apply our Western standards of social isolation to a hand-to-mouth culture. People have to go to the market — that’s where they get their food and make living wages. There was no such thing as working from home.
The government established curfews to promote social distancing, which ended up triggering a lot of violence. Some were the product of clashes with police who tried to keep people off the streets. But we also saw an uptick in domestic violence as people were forced to stay at home — often in large extended settings with spouses, children, grandparents, aunts, and uncles.
You grew up in Allison Park, one of Pittsburgh’s northern communities. What brought you back to your hometown?
When I thought about coming back to the United States, I remembered the inequity I saw as a child. Pittsburgh doesn’t have the best track record when it comes to race relations. I also read the statistics about the maternal mortality rate of Black women in the city. In looking for a new place to serve, I thought what better place than my hometown? Here, I could advocate not only for my patients, but for trainees and community members.
What was it like growing up in the suburbs?
It wasn’t until I went to Kenya that I found the words to describe my experience growing up here. In Kenya, a child of missionaries is called a “third culture child” — someone who lives abroad and is being raised in a different culture than that of their parents. In many ways, that concept describes my own experience. My parents are generational African Americans. My dad’s family lived in Pittsburgh’s Hill District for generations. My mom grew up in Virginia in an all-Black community. She never really interacted with White people until she attended graduate school. So, in many ways, I was raised in a culture that my parents did not come from. Like other third culture children, I experienced and learned to navigate the world a little differently than my peers.
My dad had a difficult decision: Should he move our family to the community he grew up in, where the schools were not well-resourced? Or should we move to an area where there are very good schools, but no opportunity to integrate culturally? Conversely, my mom — who grew up in the repressed Jim Crow South but had experienced the freedom of the Black Power movement of the 1970s — would be raising her children in White suburbs where there were few other Black mothers.
In the 1990s and early 2000s, people didn’t talk about racism publicly. The name of the game was assimilation: To fit in, you learned not to talk about it.
Growing up, my parents would tell their stories, but it was hard for me to put them in context. It wasn’t until I took several African American history classes at Harvard— which was one of the first African American studies programs in the country — that everything started to come together. Today, I’m often surprised that the majority culture in America has no understanding of the story of racism. It’s something that I was told about in my childhood; it was also something I experienced as a child, as an adolescent, and as a professional.
I think we’ve made racism a false dichotomy in America. Things are either racist or not racist; being racist is bad and not being racist is good. But that definition really leaves little room for exploration in the middle, which is where we all live.
The reality is we’re all human beings. We all have biases and prejudices. We need to be able to talk about this subject bravely. Some people are afraid to do so, feeling like they don’t have the vocabulary or know the history. It’s an admittedly hard discussion, but we have to evolve to a place where we’re not just at opposite ends of this dichotomy, but in the middle. That’s where we’ll grow.
And when we talk about racism, we immediately think Black versus White. But we also need to consider the larger issue of anti-Blackness. The world’s a big place with people of color everywhere. Anti-Blackness in America creates a hierarchy that puts Whites at the top of the pyramid and the darkest people of the African diaspora at the bottom. In between, we slot other people of color.
But anti-Blackness isn’t just limited to America. I saw it in Sub-Saharan Africa as a legacy of colonization. Unfortunately, both anti-Blackness and the resulting prejudices and inequities that come from it — including health care — are global phenomena we need to learn from and better understand.
When did you decide to become a doctor?
My high school had very few Black students. My junior year, I applied to a summer science program for high-achieving minority students at Massachusetts Institute for Technology. I didn’t even tell my parents I was applying — and I got accepted! It opened my eyes and I connected with students of color from all over the country. I made some of my closest friends there.
A family friend who is a well-known Black doctor here in Pittsburgh encouraged me to apply to her alma mater, Harvard University. I was accepted and started as a physics major. When I found I didn’t much like my studies, she told me I had what it takes to do well in medical school.
My father battled muscular sclerosis for years, and seeing him decline while I was in college cemented my desire to pursue a medical career. He died shortly before my graduation, knowing that I had been admitted to Duke.
What are your goals now that you’re part of the UPMC and Pitt family?
I’m still finding my way since starting here last fall, but one of my academic research interests is health inequities, specifically those related to pediatric orthopaedics. There are several pediatric orthopaedic conditions that attribute being Black as a risk factor, but with little insight as to why. What are the social determinants of these conditions? Are they based on where people live, on body mass index (BMI), on diet? I’d like to help medicine understand the connection.
I also want to be involved with diversity, equity, and inclusion efforts in my roles at the University of Pittsburgh, UPMC, and UPMC Children’s. I’d like to not only help raise awareness, but also develop strategies for improvement.
Can you talk about your involvement in the Gladden Society and why it’s important to you?
The Gladden Society is named in honor of the first Black orthopaedic surgeon to be board-certified. To provide some context, there are about 28,000 board-certified orthopaedic surgeons in the United States today. About 2.5% of them are Black and fewer than 15% of that small number are Black women. The Gladden Society helps Black orthopaedic surgeons network, find support, and connect to opportunities. It’s also committed to further diversifying the field with people of all colors.
Why is this important in terms of health equity and health outcomes? There’s a fair amount of literature that shows there are better health outcomes and more satisfactory physician/patient relationships when there’s racial concordance between doctors and their patients.
Another example is literature that suggests African Americans get fewer joint replacements, or get joint replacements at a much later stage, than their White counterparts — despite the fact that both groups get advanced arthritis on an equal basis. Organizations like the Gladden Society can help shine a light on and hopefully change racially-based disparities like that.
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