A Global Journey: Understanding Centuries of Black Exclusion and Erasure in Healthcare

Sugarcane plantations reigned supreme in Trelawny, Jamaica, in the late 1700s, when there were more than one hundred estates. The parish, covered by loamy rainforest soil, was established in 1770 by combining land from St. Ann and St. James into the community that bore then governor Sir William Trelawny’s name.

John Tharp, a wealthy planter who owned most of the estates, was the largest slave owner on the island, at one point in the early 1800s possessing more than two thousand people. He also owned ships in the busy trading port of Falmouth. This is how my ancestors first arrived in the Western Hemisphere, enslaved subjects of the British empire.

To understand representation in medicine and the conditions of Black folks’ health, we can’t turn just to the stories of a single nation. It is a global journey, one that connects us to the legacy of slavery everywhere. This paternal land of mine, Jamaica, the one that birthed my great-grandfather’s dreams, also shaped his experiences with discrimination in medicine, from the battlefields to the doors of medical institutions that slammed shut. His story echoes those of countless Black physicians across generations and borders. So I must begin here.

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The British empire keeps better records than those I can find in the United States for my maternal family, but even in Jamaica, it’s disheartening to see the way our family’s surname is butchered (with more than three spellings), and the way our history ends with so little documentation, like we don’t matter, like we didn’t exist. I’m fortunate to find what I do dig up in manumission records.

To understand representation in medicine and the conditions of Black folks’ health, we can’t turn just to the stories of a single nation. It is a global journey, one that connects us to the legacy of slavery everywhere.

It was in Trelawny Parish where my great-grandfather’s maternal grandmother, Sarah, was sold as a baby alongside family members to John Tharp and other landowners. Men gathered at village auctions to grope and prod Black people; the shapes of their muscles and strength of their teeth determined their value, babies included. At some point in her early life, likely through legal channels, Sarah was freed. In 1834, between the massive columns at the old King’s House in Spanish Town, a British administrator announced emancipation of enslaved Jamaicans.

Be it enacted, that all and every one of the persons who on the first day of August one thousand eight hundred and thirty four, shall be holden in slavery within such British colony as aforesaid, shall, upon and from and after the said first day of August, one thousand eight hundred and thirty-four, become and be to all intents and purposes free and discharged from all manner of slavery, and shall be absolutely and forever manumitted.

It would be years before full emancipation. The British Parliament had built restrictions into the freedom edict to guarantee the enslaved and newly free would continue laboring, either for poverty wages or to repay bottomless debt. The agreement was as follows:

Children under the age of six would be free. Those older than six could gain freedom, but only after working half a dozen years through plantation apprenticeships. And those born after emancipation were “free to struggle,” trapped in low-wage jobs like the duties of the formerly enslaved.

John Vine Furgurson, my paternal great-great-grandfather, fell into the struggle category.

He was born around 1855 in the First Hill neighborhood, a tiny village just southwest of Montego Bay along the north shore. While I can find no record of his parents, this was a period when many Colored youth were orphaned in the cholera epidemic that raged some our years earlier. They were often portrayed by White planters as lazy, unwilling to work for themselves, and prone to committing crimes on plantation estates, the image of the destitute, abandoned child associated with thievery rather than survival.

Despite his beginnings, John Vine grew up to work as a mason and laborer, with rail-straight posture, a dark round face, a wide nose, and a neatly trimmed goatee. In a photo taken later in his life, he wears a loose-fitting suit and with an air of authority and pride poses under coconut trees. I imagine it unlikely that he was considered one of the lazy, rum-drunk thieves stealing food. He seemed disciplined. And in that photo, I see a man who if he had been living in a different time would have carried himself just as proudly, but would have had more opportunity. The kind of opportunity his son would one day chase and ultimately achieve.

John Vine fathered his youngest son, my great-grandfather Lawrence St. Clair Ferguson, with his wife, Sarah, who was more than fifteen years his senior. They’d been married for seventeen years at the time and had five other children. John Vine sowed his seeds for perhaps as long as he could, giving my great-grandfather many sisters and brothers and half-siblings with close birthdays across the island. Sarah likely knew she shared her husband with many women around the parish. Yet there she was, for the sixth time, bearing Vine’s child, a boy who would defy the circumstances of most who hailed from the impoverished community. As a tribute to her own mother, Sarah chose the name Lawrence St. Clair Ferguson. Everyone called him Fergie.

The family was Catholic, an uncommon choice of religion on the island at the time. When the island switched from Spanish to British colonial rule, Roman Catholics were noted to be a rarity, as the religion was said to have been “proscribed and forced underground” when the Church of England took hold on the island. Catholics began to resurface around 1837 with another wave of European migrants who evangelized in the streets and in the name of the poor and immigrants. I imagined these missionaries touched and converted my family.

A German Jesuit by the name of Reverend William Spillman came to the island and would compose a “simple mass” that would go on to be sung by Negroes in small country churches everywhere. When those Negroes sang “Gloria,” “Kyrie,” “Credo,” or “Sanctus,” whether it be in the old country church or between the walls of the Kingston prison, where Father Spillman evangelized, visiting priests noted their voices were so mighty, they did not need organs, which were in high demand but low supply.

Fergie attended Falmouth High as part of the class of 1913, and while he grew up with an abundance of family and faith, the struggle for food and decent-paying work remained. The land was fit for sugarcane fields, but little else. So on market days, local Colored laborers would follow in the tradition of the formerly enslaved, riding donkeys, horses, or rowing boats to other parishes where food was in greater supply and available for sale.

Beyond these trips to other nearby parishes, no one in Fergie’s family had traveled far from home. No one he knew owned property. But in 1915, when Fergie was twenty-two, a massive ship arrived in Kingston Harbour, and with it, a grand opportunity.

Across an ocean, the war that King George V found himself knee-deep in had begun more than a year prior, when a Bosnian Serb assassinated the heir to the Austro-Hungarian throne. The British empire joined the fight in August of 1914. As tens of thousands of his men were slaughtered, it didn’t take King George long to realize he needed reinforcements. The king knew he had willing recruits in Africa and the Caribbean colonies, since thousands of volunteers had been turned away at the start of the conflict. But the empire’s military leaders feared that should His Majesty recruit Negroes, the Germans would mock the British forces. It would be an embarrassment to admit that their ability to fight was dependent upon enlisting an “inferior” class of darkies.

Furthermore, the head of the British War Office, war minister Lord Kitchener, did not want Black men to fight on behalf of the Crown because of what he perceived as their incompetence. A 1914 War Office memo stated: “He [Kitchener] is therefore of the opinion that in the hands of such Natives they would be a greater source of danger to their friends than the enemy.” Another memo to the king from the War Office expressed a different concern. “In as much as no West Indian contingent (composed of Black men) is serving in Europe…their colour would render them as conspicuous as officers used to be in the olden days on consequence of wearing a uniform which made them dangerously distinctive from the rank and file.” In other words, dark-skinned men will stand out dangerously in a sea of soldiers.

But by 1915, the empire had no choice, men were dying by the thousands. Skin color could not be a barrier to replenishing the ranks. Lord Stamfordham, the king’s private secretary, firmly pushed Secretary Kitchener toward a change of heart on the king’s behalf. Stamfordham, a military veteran with a thick drooping mustache and receding hairline, sat down at his desk in Windsor Castle on April 17 and penned a note to the War Office. “His Majesty cannot help thinking that it could be very politic to gratify the wishes of the West Indies to send a regiment to the front,” he wrote. Knowing Kitchener was concerned about the Black troops standing out, he suggested they go to a place where their dark skin would be less conspicuous on the battlefield: “They might be useful in Egypt.”

A week later, Lord Kitchener agreed, with a caveat. He would decide where the Black troops served. The king got his way, and the British empire began recruiting from every corner of the globe, where one in four people, many who looked nothing like his pale, pinkish self, owed him their allegiance and loyalty, having been colonized by the Crown.

Soon recruitment posters appeared all over the Caribbean. In them, Lord Kitchener, sporting a gold-braided hat and a massive mustache, points a gloved finger toward eager recruits: “YOU, Black men of Barbados, Trinidad, the Bahamas and Jamaica, need to join forces!”

The War Office made rounds between the islands, hanging handbills across the parishes: “The British Empire is engaged in a Life and Death Struggle!” “COME FORWARD TO FIGHT,” posters commanded in large bold capital letters. “What is the matter with YOU? Put yourself right with your King…put yourself right with yourself and your conscience.”

The campaigns worked. Many sons of formerly enslaved mothers and fathers jumped at the opportunity. Here was a chance for them to prove they were just as capable as soldiers and to provide for their families. The propaganda captured the hearts and minds of more than 15,000 volunteers from the islands, about 66 percent of whom came from Jamaica. Fergie was drawn to the promise of honor and opportunity that came with representing one’s country on the world stage. He wanted in.

On the last Monday in November, British military men came through Falmouth, passing the Georgian homes where Fergie spent his school days. The men arrived at the clock tower and marketplace named after the king and urged the darker working-class men to meet them by the sea. The next day, young Black hopefuls descended on Central Wharf, a bustling boatyard in the seaside town, to hear what the men had to say.

A medical man, Dr. Simeon Theophilus Vine, stood on a platform above the crowd of Black men.

“Three cheers for the King!” Vine shouted. Men dressed in laborers’ rags responded with a triple roar for His Majesty.

Dr. Vine came from a prominent and powerful family and was notorious for his temper and flamboyant behavior. He also had a reputation for performing rough surgeries on children and fighting in the streets. But on this day, he was deemed a worthy spokesperson by colonial administrators to encourage war service from the lower class.

“My friends, we are here to try and get men to fight our enemies,” the doctor said. If he had been twenty years younger, he would volunteer himself, he told them, to fight the “enemies that hate and want to annihilate us.” The crowd roared.

“We only want men who are not cowards,” Dr. Vine continued. “Young men, will you not seek the noble duty to do it? Instead of remaining to live a life of dissipative [sic] which wears out the body for the grave? You can now go and become a decent self-respecting man, a man made fit for anything useful.”

Dr. Vine tapped into the masculine consciousness. “Is there any woman keeping you?” he taunted. “Loose the tie and go and save your country…The man who does this and falls in field of battle is regarded as a true hero.”

I wish I could have told my great-grandfather that rarely do the rewards match the promises. That what was offered in pensions, in property, and in dignity could never be trusted to match what was taken.

But there were limits to what the British believed heroism would look like in the face of the enemy. Fergie quickly learned that all commanding officers were White, and no Black troops could achieve a rank higher than sergeant. But this didn’t matter, because he knew that those in power would always write the rules of opportunity.

White ministers, who were often trusted among the descendants of the formerly enslaved, also played a key role in shaping public opinion. In Oracabessa, Reverend W. D. Henderson, a Baptist minister, urged men to enlist, not just out of duty, but out of fear and gratitude. “Every man should say, ‘I will not rest until our young men go forward and join in this great struggle,’” he declared. “To be under German rule would be to be enslaved.” He reminded them that when there was talk of America purchasing Jamaica, the cry of every Jamaican had been No! England, he argued, had always come forward with money and means to help Jamaica. Now was the time to return the favor.

A British lieutenant took a similar approach when he addressed the men of St. Ann Parish. “You do not want to be slaves?” he asked.

“No, no!” the men exclaimed.

“Well, you must do your part in joining to fight the Germans. We can’t lose, but this opportunity comes but once in a lifetime. When Britain will have crushed Prussian militarism, we shall be having lasting peace, wealth and freedom.”

As the poor young men signed their names to recruitment rolls, bands played “Britannia, the Pride of the Ocean” and “Rule, Britannia.”

Britons never, never, never will be slaves.

Rule, Britannia! Britannia, rule the waves!

Britons never, never, never will be slaves.

That idea of true freedom that comes with financial stability hypnotized young men like Fergie. And for those who were never afforded schooling, the war office had scrapped the reading and writing exams once required to enter the forces.

For Fergie, joining the military didn’t just appeal to his ego and ambition. Fergie’s mother, Sarah, expected him to help support the family, but it hadn’t been easy. Planters like his father earned just nine pence a day. When women went to work, they earned three pence less. Fergie’s family, like so many at the time, were reeling from a hurricane that ravaged the island four weeks earlier on its way to slam into Galveston, Texas. The storm hit Jamaica on August 12, splintering three hundred homes, and 90 percent of banana crops rotted to black in the post-storm humidity. Rail lines were torn from the soil near Buff Bay. Then in September, floods drowned islanders living in Clarendon and submerged what was left of the banana harvest.

It was on the heels of these disasters that Fergie stood ready for service at Port Royal in Kingston Harbour, in December 1915, on the shores of his tropical island. Like many of his friends, he was equipped with an athletic physique. He was also handsome, with a broad chest, deep black eyes, full lips, and lovely teeth. His dark chocolate skin was something that colonial recruitment offices had rejected in volunteers just one year before. But times were changing, and Fergie was among the Colored men assigned to what would become a fourth battalion in the third contingency of the British West Indies Regiment. Among the compensation promised by the Crown for their services were pensions, land, and decent wages.

I wish I could have told my great-grandfather that rarely do the rewards match the promises. That what was offered in pensions, in property, and in dignity could never be trusted to match what was taken. That his body, and those of all the other Blacks chasing opportunity, would be counted when it served their cause, and erased when it didn’t. That long after the war ended, debate about whether men like him were deserving of recognition and reparation would continue.

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Adapted from The Price of Exclusion: The Pursuit of Healthcare in a Segregated Nation by Nicole Carr. Copyright © 2026 by Nicole Carr. Reprinted by permission of Dey Street Books, an imprint of HarperCollins Publishers. All rights reserved.