“They say if you listen closely, you can hear what wasn’t said.
Whole truths live in that hush—too holy for the report, too loud for the meeting minutes.”

From Mira’s field notes

I knew the mobile unit was gone before I even asked.

The corner it used to idle on, just outside the rec center, was quiet.
No folding chairs with metal feet scraping against concrete when kids got restless.
No children with runny noses or that deep, open-mouthed breathing you learn to recognize.
No Mrs. Juanita waving folks down with that clipboard she never set aside—her nails always done, always long.
Today they were a deep navy blue with rhinestones.

It had been six months since I’d submitted the evaluation for the county’s mobile asthma van, and three since they’d quietly ended the program.

“Outcomes didn’t meet expectations,” my director said.

But I knew better. The community met them. Exceeded them.
The department just didn’t know how to keep showing up once the pilot funding dried up.

I called Ms. Beverly anyway.
She laughed the way my grandmother used to—more gravel than joy.

“I knew it wouldn’t last,” she said.
“They don’t build roots, baby. They build reports.”

I think of Ms. Beverly whenever the language gets thick with words like sustainability and engagement.
She’s not a focus-group respondent. She’s the reason we had any numbers to show at all.

Her grandson nicknamed the van the wheeze bus.
He was six when it first came. Eleven when it stopped.
He’s thirteen now, and his inhaler sits on the windowsill like a relic.

The silence where that van used to be isn’t just programmatic.
It’s personal.

When I write my final reports, I try not to sanitize.
But the templates ask me to.

They want to know what “didn’t work.”
They don’t ask how the silence afterward lands on a community’s chest like a second diagnosis.

Implications for Practice

Silence is data.
Track what happens when care is removed—not just when it’s deployed.

Endings are part of the work.
Design for them, document them, learn from them.

Return calls.
Even when the program ends. Especially when it ends.

Trust doesn’t pause.
It calcifies, or it re-forms somewhere else.
Pay attention to where it goes.

“They always want to know what worked,” Ms. Beverly told me once.
“But they never ask why it stopped.”

Then she paused, like she was counting the ways she’d seen care come and go.

“They ask what it cost—but never who prayed for it.
They ask who benefited—but not who had to learn to live without it.
They ask what was left behind—but not what that absence became.
They ask who’s still waiting—but not who stopped believing anyone was coming.”

Some days, I want to write those questions on the cover of every report I’ve ever submitted.
In red.

©2025 La’Quana Williams, MPH · A Mercy in the Telling

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Narrative:

Mira stood in her kitchen, staring at the fridge, when the memory washed over her.

She remembered the Women, Infants, and Children (WIC) clinic — one of the few units in the health department that consistently did well. The staff there handled babies gently, laying them on scales padded with fresh paper that crinkled beneath them, cooing while measuring length and weight. Sometimes they slipped mothers free diapers, wipes, or an extra can of formula when they could.

She had been on WIC when she had her first son. The ebony-skinned women at the office rubbed Mira’s back and smiled proudly when she shared that she was exclusively breastfeeding. She was the first in her family to do so — just like graduating college — yet here she was, sitting in that office. The staff printed checks double the size of normal ones. On them, a short list of foods she was allowed to purchase:

• Cheese (orange, yellow, or white only)

• Milk (low or nonfat only)

• Yogurt (low or nonfat only)

• Tofu (she’d never even had tofu!)

• 100% whole wheat bread

She watched the required video and walked quickly from the store with her baby on her hip. It was a sweltering day, and it seemed as though her flip flops might melt as they stuck to the blacktop in the parking lot.

She learned the tricks of the WIC shopping trade quickly. She had never been taught to read labels by her mother, who seemed to have items call out to her as she moved through the grocery store with little Mira by her side.

She bought frozen juice concentrate, mixing it with water because it stretched further than the bottled stuff. She dropped bags of dried beans and peas into her cart. Those took a long time to soak and cook, so Mira saved them for Sunday dinners. They piled up high in her cabinets, but she didn’t mind — at least the shelves looked full. She grabbed boxed grits and unsweetened dry cereals to pour over the low-fat milk. She always sprinkled a spoonful of sugar on top anyway, along with exactly two ice cubes.

Milk was the hardest to manage, but she needed it for her oldest son. The checks often came with several gallons at once — far too heavy to carry home on the bus. Mira remembered watching other women quietly forfeit a gallon or two at the register. The sell-by dates were often too close to the current day to risk spoilage. It was on the WIC program that she first purchased whole wheat bread. Not the white kind that stuck to the roof of your mouth, spread with a layer of mayo, and sandwiched between fried bologna and cheese that barely melted.

On several occasions, clerks shut down the line once she handed over the checks with an exasperated yell, “It’s gon’ be a while!” Mira held her head high, sometimes fighting back tears as her baby cried in the cart while they waited.

The Supplemental Nutrition Assistance Program (SNAP) stretched things further — $231 dollars a month further, to be exact. Mira’s aunt had urged her to apply. “Just until y’all get on your feet, baby. It ain’t forever.” With SNAP, she had more purchasing power, but the shame fell on her heavier. A few months before she applied, she was interning when she overheard a city council member complain about being behind a woman in the store with two kids buying instant noodles and spicy chips. Did he really think people didn’t deserve to buy a few things they wanted to, just because they were poor?

That night, she made pork chops with seasoning salt, black pepper, garlic & onion powder, and paprika. She dredged the meat in seasoned flour and laid the chops into a skillet hot with oil. The sizzle filled the kitchen, sharp and loud, until the meat turned golden at the edges. She boiled the canned sweet corn, stirring in butter and salt until it glistened. She cooked the rice plain, then sprinkled sugar over the steaming bowl and stirred in butter until it clung to each grain.

Her husband shook his head when he came to the table. “We shouldn’t be eatin’ no swine,” he said, watching her plate. Mira only smiled faintly, biting into the crisp crust anyway. Hunger won over his rules.

They ate together, her baby cradled nearby, the smell of fried pork filling the small apartment. For a moment, the shame of the line, the stares, the weight of the checks melted into the flavor of a meal that was hers.

Years later, long after those dinners, her phone buzzed. It was her aunt.

“What you makin’ for dinner tonight, baby?”

Mira looked at the fridge. “Nothin,” she said. “Leftover baked chicken with broccoli.”

“No rice or smothered potatoes?” her aunt yelped.

“No ma’am, I’m tryin’ to watch my carbs,” Mira laughed.

Her aunt scoffed. “Tell yo uncle about that big title they gave you down at the health department. I can’t for the life of me remember what you do down there, but I like the sound of that title!”

Mira spoke it: Director of… She let the words trail, realizing she couldn’t remember the last time she had taken the time to make one of those Sunday meals like she used to. Perhaps she had traded the hours at the stove for the badge clipped to her blazer — the one that read, in small print on the back, something about being a first responder in case of a disaster.

I didn’t sign up for this shit, she huffed.

©2025 La’Quana Williams, MPH · A Mercy in the Telling

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Key Themes

• Food as a determinant of health

• Dignity and ritual embedded in eating practices

• Stigma and shame produced at points of access

• Everyday creativity and resilience as evidence

Health Outcomes

• Stress responses tied to stigma and surveillance in stores

• Maternal mental health impacts from navigating scarcity

• Intergenerational eating patterns shaped by benefits programs

• Small consistencies in access leading to healthier infant outcomes

Systemic Failures

• Benefit design emphasizing restriction over choice

• Public health framing survival as a transaction

• Policy rhetoric that polices the diets of the poor

• Burdens of transportation, spoilage, and weight of provisions

• Structural shaming built into distribution and checkout processes

Community Assets and Strengths

• Mothers creating meals that stretch rations into care

• Knowledge-sharing among women on how to shop and prepare

• Intergenerational food memories as anchors of resilience

• Kitchens as spaces of transformation, not just consumption

• Gratitude and forward-looking hope carried in daily meals

Reflection Questions for Practitioners

• Where do shame, stigma, or surveillance show up in food access — and how do these shape health outcomes?

• How are transportation, storage, and spoilage risks factored (or not factored) into benefit design?

• In what ways do benefits programs treat families as problems to be managed, rather than partners in defining nourishment?

• How do intergenerational food memories — from an apple in a grocery store to sugared rice at a Sunday meal — carry evidence of health and resilience?

• Where are families already demonstrating creativity in transforming limited provisions into sustaining meals? How could public health honor and support that?

• How might public health name the small consistencies that “worked” (gentle handling of babies, reliable access to certain foods) and build from them, instead of defaulting to restriction?

• What would it look like to measure dignity, care, or ritual in food access — alongside nutrients and calories?

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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This case study explores how safety is a determinant of health—not through crime statistics, but through infrastructure, investment, and the uneven distribution of care in public space. This absence of safety (subtle, structural, and racialized) shows how public health often fails to name neglect as harm, even as communities continue to create practices of light, care, and protection.

Narrative

The streetlight on Mira’s block hadn’t worked in months.
She noticed it every evening as she walked home, the sky turning that deep shade of navy that made shapes blur together. Shadows clung to corners, stretching across cracked sidewalks like nets.

But inside the homes, it was different. The faint glow of stove burners and lamps spilled through curtains. Television screens flickered blue across living rooms. Candles lit kitchen tables where homework was spread. Porch bulbs, incense, and sage burned steady through the night, casting soft halos as signifiers that people were there. Even as the street stayed dark, the houses pulsed with light. Safety, for many, lived at the threshold.

At the end of the block, the puff factory’s stacks glowed steady. A thrum of machines pulsed through the air, a reminder that some lights never went out. The factory was lit like a beacon, a sign of investment and permanence, even as the neighborhoods around it slipped into shadow.

Mira paused at the corner, her keys wedged between her fingers. She told herself it was habit, not fear. But the truth was, she never felt entirely safe walking the three blocks from the bus stop. Not because of people. But because of what the city had failed to do.

That was the part public health rarely named. Fear didn’t only come from crime or assault; it lived in the cracks of sidewalks never repaired, in bulbs that stayed burned out, in bus stops left bare against the rain. Neglect was its own kind of violence, slow, sanctioned, and measurable in stress hormones and shortened breath.

Other neighborhoods had working lamps, smooth pavement, benches with roofs overhead. Those weren’t luxuries; they were protections. Brackridge was given less, and then told to make do. The absence itself became evidence: of who mattered, and who didn’t.

Mira later learned that these fixes didn’t fall to the health department but to public works—and only when residents called them in. In some neighborhoods, people reported damn near everything from potholes to trash cans, and officials responded. But in Brackridge, a call about a streetlight could invite something else: more patrols, more eyes, another layer of surveillance.

The people in Brackridge didn’t have much trust for county or city officials. “Close the blinds and go sit down in your room,” her mother would say when the public health survey teams came by asking about asthma, food access, or neighborhood conditions. The family avoided them the way they avoided Jehovah’s Witnesses who regularly stopped by. And when her mother did open the door, she kept it tight, barely wide enough to show her slender frame. She was curt, muttering curse words under her breath once the door was shut. “I ain’t wastin’ my breath on them people. They ain’t gone do nothin’ but let it go in one ear and out the other.”

Most residents bottled up these issues until they burst in community engagement meetings—like a storm breaking open, flooding the room and drenching even those on a lifelong mission to “do good work.” Other times officials nodded, took notes, promised review. Then months passed, and nothing changed. The silence was the worst part. No updates, no timelines, no acknowledgement of what people were living with each night.

Yet, when Mira sat in health department briefings, she often saw numbers appear elsewhere: coded into dashboards, plotted on GIS maps, overlaid with cheerful colors meant to show “progress.” The outages weren’t invisible to the system. They were documented, just never addressed.

Public health had language for gun violence, for assaults, for trauma that came with headlines. But it didn’t have language for this kind of safety, for the way a broken bulb could elevate cortisol, tighten a chest, make a walk home feel like a risk.

Mira thought about her mother’s heart, her grandmother’s lungs, the way chronic stress calcified inside them. Safety wasn’t just about what happened. It was about what might. The anticipation was its own weight.

On nights like this one, when it was hard to catch her breath, she took off her shoes at the door and swayed her hips to jazz music. She knew how important it was to move that energy through the body rather than let it metastasize. Sometimes she sprinkled salt across the doorway and swept it out slowly, just as her grandmother had taught her.

Salt was more than ritual. It was protection.
A way to purify what was inside, to ward off what didn’t belong, to invite prosperity and hold on to good luck.

Her grandmother had taught her to sweep the doorway clean,
but Mira had added her own practice.
She burned incense, sat cross-legged, belly loose, eyes closed,
folding yoga into the lineage she inherited,
an unbroken thread of women making their own medicine
from breath, smoke, and memory.

These practices held her.

They lit what the city left dark.

And when she opened her journal to write them down at the end of each day, it wasn’t just memory.
It was evidence.

©2025 La’Quana Williams, MPH · A Mercy in the Telling

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Key Themes

• Safety as a determinant of health

• Infrastructure neglect as racialized harm

• Chronic stress from unsafe environments

• Absence and silence as forms of public health neglect

• Everyday practices of light, care, and protection as evidence

Health Outcomes

• Elevated cortisol and chronic stress responses

• Increased risk of hypertension and heart disease

• Reduced physical activity due to unsafe conditions

• Mental health strain from anticipatory fear and hypervigilance

• Intergenerational impacts of stress on cardiovascular and respiratory health

Systemic Failures

• Infrastructure disinvestment in Black neighborhoods

• Call-in reporting systems that reproduce inequity

• Public health ignoring structural safety issues

• Budgetary neglect framed as “neutral” or “apolitical”

• Data captured (dashboards, GIS maps) but not acted upon

Community Assets and Strengths

• Porch lights, candles, and home illumination as community-created safety

• Cultural practices of cleansing and protection (salt, ritual, music, yoga, journaling)

• Residents’ vigilance and adaptation strategies

• Oral testimony and memory as evidence

• Intergenerational practices of care and energy-clearing passed down and reimagined

Reflection Questions for Practitioners

• How do you define “safety”? What gets left out of that definition?

• Where in your community are the “lights that don’t come on”—the absences that shape daily health but rarely get named?

• What health outcomes might be linked to infrastructure neglect, even if they aren’t tracked in your data systems?

• What forms of light, care, or protection are already being created by communities themselves? How could public health recognize and support these as evidence?

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

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Key themes: political neutrality in public health, survival at the margins, data without context, institutional credibility vs. community trust.

Salt for Preservation
The Earl Grey tea was piping hot. Mira preferred it that way in such sterile environments. These spaces often made her uncomfortable—made her stomach turn sideways, as her grandmother would say. Her real preference was iced coffee, but hot tea soothed her and kept her hands busy. She wrapped her long fingers around the paper cup, feeling it soften under her grip while the facilitator clicked to the first slide: Public Health: Our Core Mission.

The words on the screen were stripped bare:

• Prevention

• Protection

• Promotion

Beneath them, a tidy list—

• immunizations

• inspections

• screenings

None of it spoke to the weight of waiting rooms or the exhaustion of being poor and sick in Brackridge.

“This is what we do,” the facilitator said, her voice practiced, almost cheerful.

Mira raised her hand, heat rising in her belly the way it always did when she needed to speak in front of an audience. “Where do housing, wages, or food security fit in here?”

The facilitator smiled, polite and thin. “That’s so important, Mira! But not really in our lane. That’s housing’s job, or labor, or social services. We work with what we can measure through the data.”

In the back, an older woman nodded with the weary recognition of someone who’d heard this before.

Grits n Eggs
The words not our lane clung to Mira like smoke. They pulled her back, suddenly she was nineteen again, standing in a church basement. Women from the neighborhood spooned steaming bowls of cream of wheat, grits, and scrambled eggs into paper bowls for a line of kids whose hunger showed in their quiet patience. A crate of oranges sat by the door, donated from a corner store; the bread, still soft though yesterday’s, had come from the bakery down the street.

“Can’t focus on no empty stomach,” one of the women told her.

At the time, Mira hadn’t thought to ask how the food arrived each morning. Later she learned: shopkeepers dropped off what they couldn’t sell, churches lent their kitchens, and Panthers went door to door collecting whatever neighbors could spare.

Years later, Mira would understand that breakfast was only one piece. The Panthers had also run health screenings in barbershops, tested for sickle cell, fought landlords over lead paint. They hadn’t asked permission to love people whole. They hadn’t stayed in their lane.

Their work rippled outward, so effective and undeniable that federal school lunch programs soon expanded, taking directly from the model the Panthers had already built.

Apolitical
Back in the conference room, the deputy director took the floor for the next tidy section, Navigating Political Environments, her suit and tone both sharp.

“Our department must remain neutral on political issues,” she said smoothly. “Even if something touches health—policing, minimum wage—we present the data and let elected officials decide. Some topics are better left untouched.”

The words landed wrong. Mira felt another question rise, hot and insistent. She swallowed it, though the thought burned in her chest: But those are health issues.

The deputy continued. “Our credibility depends on avoiding political entanglements. We provide the data; others argue the politics. That way, our hands stay clean.”

Mr. Williams, longtime Director of Community Health Engagement, leaned forward, his shirt wrinkled at the bottom from the weight of his protruding belly. “Sometimes the evidence is pretty clear about what needs to happen.” His voice was gravel and silk all in one. His words lingered. The deputy’s smile tightened.

See Through
During the chronic disease update, slides rolled past in cheerful fonts: Know Your Numbers Blood Pressure Campaign. Eat Fresh This Fall. Smiling stock-photo faces, untouched by the realities of rent or medication costs.

“What happens after someone learns they have high blood pressure?” Mira asked. She added warmly, “Sometimes this comes up in our community engagement sessions, and I’d like to be able to point people in the right direction.”

A man in the front row chuckled. “We don’t run clinics. Prevention’s our focus. Treatment’s on the medical side.”

“Actually,” said a young epidemiologist, still typing. “We piloted community health worker follow-ups last year. Funding was cut, but the outcomes were strong—people stayed in care, controlled their blood pressure.” She looked up, eyes steady. “It worked.”

Mira quickly jotted the note down. Others in the department seemingly ignored these gaps, but as the Health Equity Lead, she was often fielding questions from community members in grocery store lines and at daycare pickup. Just last week, the local NAACP chapter asked if the department could share blood pressure referrals after hosting a wellness fair; the month before, The Links had raised concerns about maternal health. These were the connections she relied on.

The facilitator cleared her throat and clicked to the next slide. She knew the programs, but not the heart of the issue, unable to connect practice to the people it was meant to serve. Mira, though, had learned to read between the lines, to listen for the fissures in what was left unsaid. It was her quiet superpower—the ability to hear where the system cracked, and where possibility might still break through.

Margins
The real exhaustion came from the constant translating—from hearing what was said in the room, seeing the stripped-down slide, and then reshaping it into language her community could actually use. It was like carrying two conversations in her head at once, each running on a different frequency. By the time she leaned against the elevator doors, her temples were pulsing, a dull ache spreading just above her brow.

A poster on the wall across from her read, “Your Health, Your Choices.” All individual responsibility, no systems, Mira thought.

“That poster’s terrible,” said a voice behind her. Molly, the epidemiologist, caught up. Her tone was quick, energetic, like she hadn’t yet learned to swallow her critiques. “We should be able to name the root causes outright. But until then, the margins are what we have—and that’s where people are surviving right now. Anyway, we should grab coffee sometime!”

Doorways
That evening, Mira spread her notes across the kitchen table, still carrying the warmth of a different meeting with her. The local NAACP chapter had spoken in a language she didn’t have to bend or translate—it was already hers. While her colleagues had gone home at five, Mira went searching for Brackridge, for the voices that named what the charts and bullet points could never hold. In those rooms, people gave shape to what Brackridge was living through. She leaned on those connections, knowing they filled the gaps the data always left behind.

Frustrations sat there sharp as hunger, but so did the names and email addresses she had collected throughout the day, and a keen sense that not all doors were closed.

The next morning, she emailed Molly about the community health worker program. Next, she emailed Mr. Williams to invite him to lunch. If she was going to work within this system, she needed to learn its limits as well as its cracks.

The question wasn’t whether the work needed to happen inside or outside the system—it was how to keep pressing at its edges, how to hold onto imagination while doing the daily work of caring for people who needed to see evidence of the revolution happening in real-time.

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

Key Themes

• Neutrality vs. advocacy in public health

• Reading between the lines, listening for fissures

• Survival in the margins

• Panthers as model of community-led health

• Disconnect between data and lived reality

Systemic Failures

• Political avoidance of root causes (housing, wages, policing)

• Fragmentation between prevention and treatment

• Funding cuts to effective community programs

• Overreliance on data divorced from lived experience

• Campaigns centered on individual responsibility, not systems

Systemic Outcomes

• Loss of community trust in institutions

• Abandonment of effective programs before impact could spread

• Chronic disease burden left unaddressed by prevention-only approaches

• Communities surviving through margins rather than systems

• Entrenched inequities reinforced by avoidance of “political” root causes

Community Assets and Strengths

• Panthers’ Free Breakfast Program and health screenings

• Faith communities and local grocers/bakeries providing food

• NAACP, Links, Divine Nine, Free Masons as trusted partners

• Community health workers as connectors and advocates

• Mira’s relational power and ability to read fissures

  ---

  Discussion Questions

  • What does it mean for a public health department to claim “neutrality”? Who benefits, and who is harmed by this stance?

  • In the story, Mira recognizes her ability to “read between the lines” and hear fissures in what is left unsaid. How might this kind of listening be cultivated and valued within public health practice?

  • The Panthers refused to “stay in their lane.” What would it look like for contemporary public health institutions to take the same approach? What risks would it involve? What possibilities might open?

  • Molly names the “margins” as where people are surviving. What are examples in your own context where communities are making health possible in the margins? How can public health departments support rather than erase this work?

  • Mr. Williams insists that “sometimes the evidence is pretty clear about what needs to happen.” What examples come to mind where evidence has demanded action, but institutions failed to act? What held them back?

  • The Panthers’ programs influenced the federal school lunch program. What current community-led innovations could or should reshape public health systems today?

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

Homes Made Thick with Quiet draws on Mira's earliest memories across two generations of home—her mother’s and her grandmother’s. It explores how chronic illness, housing conditions, and environmental neglect shape health long before a person enters a clinic. Mira begins to understand that the places meant to hold and heal them were also the very sources of harm. Through the layering of silence, survival, and sensory memory, she absorbs what public health systems often miss: that illness is inherited not only through genes, but through geography, air, and shame.

What also emerges is a blueprint for resilience. From incense smoke to food that holds memory, Mira’s family developed practices of survival and care that live outside medical charts. These aren’t just anecdotes—they are evidence.

The first time Mira called 911 alone, her mother was on the floor.

One hand on her chest. The other reaching—not frantic, just… searching.
Like she’d lost something in the air.

“Is she breathing?” the dispatcher asked.

Mira counted. “Yes. But slow.”

She gave the apartment number. Told them to buzz twice.
Gathered the pill bottles. Set her mother’s ID on the entry table.

She waited by the door, calm in the way adults later called “mature.”
They didn’t see the inside of her cheeks—bitten raw.
Didn’t notice her cuticles wrapped in tissue.
Didn’t ask how often she chewed gum until her jaw ached, just to keep from crying.

Even then, her body knew what her voice never said.

But that’s not the only way she remembers her mother.

On Saturday mornings, the house came alive.
Her mother played Anita Baker on the record player while she swept and burned incense.
She beat thick rugs outside until dust floated like glitter in the sun.
There were wicker chairs, spider plants, steamed windows, and hardwood floors that gleamed with lemon oil.

The kitchen was the heart of it.
Mac and cheese with edges that crisped.
Biscuits that opened like breath.
Everything slow-cooked, spiced, and sacred.

On good days, her mother swayed while she stirred. On hard days, she moved slower—but still showed up.

Mira learned to read these signs:
When the music didn’t begin at 6am.
When the incense didn’t burn.
When the plants weren’t turned toward the light.

That’s when she knew something was coming.
Not from a chart. From the rhythm of the house.

On the other side of town was her granny’s house.

Dim rooms. Bleach-heavy air. A wheeze that filled the space like static.
The oxygen machine never stopped humming.

Mira copied its puffs with candy cigarettes from the ice cream truck.
She thought it was funny.
Thought her grandmother’s long naps sitting straight up were just deep sleep.

The roaches taught her other things.

They didn’t hide.
They moved in the daylight—over counters, out of drains, across the lip of the stove.

Until they died… curled up in the corners of each room waiting to be swept into the dustpan.

No one ever spoke about them.
Not her granny. Not the cousins. Not her father.
They moved around the infestation like furniture.
Like shame. Like something inherited and unnamed.

Mira loved her grandmother.
But she hated that house.

Her mother never said much either—at least not in front of anyone.
But on the car ride home, she’d pass Mira a napkin and murmur,
“Don’t eat nothin’ cold from there.”
“Don’t put your bag on the floor, sit it up real high.”

She wasn’t judging. She was shielding.
The way Black women do when love sometimes means not naming the thing that’s hurting you.

Even then, Mira felt the contradiction:
That home could be both comfort and contamination.

She didn’t have the words back then.
Didn’t know about redlining or racist zoning.
Didn’t understand that code enforcement rarely crossed certain blocks.

She just knew the Raid smell clung to the curtains,
and her grandmother’s chest rattled like something inside was trying to get out.

Her grandmother lived a long time. With all of it.
The bugs. The bleach. The breaths she had to fight for.

No one ever came to inspect. They treated her at Centinela Hospital and sent her back home. No one ever came to help.

When Mira’s mother died at fifty, no one mentioned the air.

They said heart failure.
As if that was the whole story.

No one asked what she’d she’d been carrying.
Who had been watching.

Mira packed the apartment alone.

In the closet, behind old scarves and faded church fans, she found a stack of books:
Sacred Woman.
Vessels of Light: Returning to the Root.
From the Inside Out: Healing Through Food, Spirit, and Rest.

Receipts from the late '90s still tucked inside. Dog-eared pages. Underlined prayers with family member’s names written in them.

Her mother had been searching.
Not for miracles—for instruction.
For a way to live with dignity in a system that never came.

Mira sat with the books in her lap and felt something new.
Not just grief. Not just anger.

Knowing.

Her mother had been trying.
Long before the world thought to ask.

But now she names what no one did before.

Some losses come in silence. Others crawl. Either way, they stay.
They salt the edges of a woman’s life.

But so does what remains.
The rhythm.
The remembering.
The strength not just to survive—

but to name what was never named.

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

Key Themes

• Intergenerational survival and caregiving

• Environmental racism and toxic home environments

• Silence and shame as barriers to care

• Black maternal intuition and wellness practices

• Illness as context-bound, not just clinical

• Memory and sensory rhythm as health evidence

• Displacement within one’s own community

  ---

Health Outcomes

• Chronic asthma and respiratory illness

• Pediatric stress and anxiety responses (e.g., oral fixation, skin picking)

• Premature mortality (maternal heart failure at 50)

• Under-addressed mental health and grief

• Unrecognized environmental contributors to illness

• Delayed or inadequate emergency response

  ---

Systemic Failures

• Code enforcement negligence in low-income Black neighborhoods

• Pest infestations normalized and untreated

• Health care responses focused on symptoms, not setting

• Lack of institutional support for caregiver children

• No continuity between hospital care and home environment

• Absence of grief counseling or recognition of historical health trauma

  ---

Community Assets and Strengths

1. Cultural health practices (herbal healing, food as medicine, spiritual care)

2. Emotional attunement and environmental literacy passed through generations

3. Rhythms of care embedded in music, plants, and homemaking

4. Protection and transmission of unspoken knowledge

5. Strength in stillness, observation, and quiet leadership

6. Literacy and learning as resistance (mother’s health books and notes)

   ©2025 La’Quana Williams, MPH · A Mercy in the Telling

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Evidence of Things Unmeasured follows Mira as she reflects on the complicated terrain of education as both sanctuary and site of rupture. Raised in an all-Black public school filled with cultural pride but labeled “low-performing,” Mira later finds herself unprepared for the racial isolation and standardized testing demands of a predominantly white university. Her path—from Africana Studies to a public health calling—is shaped by dislocation, resistance, and return. This case explores education as a social determinant of health, the emotional toll of being first-gen, and the liberatory potential of culturally rooted learning.

Mira never had to learn to love herself in school. That part came early.

At Washington Preparatory Academy, one of the few remaining all-Black public schools in the region, she played Harriet Tubman in the fifth-grade play, debated the ethics of Booker T. Washington’s accommodationism in eighth, and underlined her favorite quotes in Beloved with a trembling pencil hand by tenth. There were murals of Audre Lorde and Thurgood Marshall in the hallway. Her favorite teacher wore Ankara skirts and kept Lucille Clifton poems taped to the whiteboard.

In the entryway, a bronze “W” was set into the tile floor. No one stepped on it. Ever. You just didn’t. Even the wildest kids curved their paths around that letter. It was a kind of reverence, unspoken and bone-deep.

They called her school “low-performing.” Everyone knew what that meant.

Yes, there were lockdowns. Yes, there were fights. And yes, there were kids Mira loved who didn’t make it out. The gang injunctions from the early 2000s meant red, blue, even purple, were off-limits. Colors could get you profiled, documented, listed. The kids adapted: white swapmeet tees, throwback jerseys, no hats. Hats were far too risky.

But the soil of that place was rich. She didn’t know it then, but she was being held. Schooled in something deeper than test prep. She knew how to show up for people. She knew how to read a room, a wound, a silence. No standardized test could measure that kind of literacy. What she didn’t know, couldn’t have known, was how far that wouldn’t take her - for now.

By the time Mira stepped onto the quad of Bellamy University, three hours north and a world away, the air changed. Only 3 percent of the student body looked like her, and none of them lived in her building. Her advisor smiled politely when she asked about crediting her AP African American History course. The boy in her poli sci class flinched when she sat beside him. No one called it racism. Not out loud.

She tested into English 101 (though she’d felt she earned higher) and remedial math - both humiliating and confusing. She’d been a straight-A student. Honors classes. Student council. But very little at Washington Prep had prepped her for the SAT or for how deeply language could be used to sort people, not just uplift them. Public health calls this “educational stratification.” Mira called it betrayal.

Still, she wanted to make good on her promise: become a judge. Fix the system. That was the deal she made with her mother, with her grandparents who helped raise her. But halfway through her sophomore year, after another painful conversation with a professor who “just didn’t see how race was relevant to constitutional law,” Mira found herself lingering outside the Africana Studies department.

She told her family she was “adding a double major.” She didn’t tell them she’d already dropped pre-law. That would come later. Her family didn’t understand. “What is public health anyway?” they asked. And then after she explained it, “You’re the first in the family to go to college, and that’s what you wanna study?”

But when she got into graduate school, a Black school this time, something clicked. She couldn’t explain it at the time. Couldn’t find the words for the pull in her gut when she read about maternal mortality, or when she mapped out redlining and asthma rates in her hometown for a class project. Public health gave her language for what she’d seen. A framework for what her people had long known bone-deep.

What came first was a class on Black health traditions. Then one on displacement and disease in post-Katrina New Orleans. A guest lecturer from the city health department mentioned something about “public health infrastructure as both prevention and liberation.” Mira wrote that down. She still has the notebook.

“There are maps written into our breath,” she once said during a class presentation. “You can trace policy by where my grandmother wheezed.”

Now, years later, Mira leads equity trainings for county health departments, rooms thick with spreadsheets, dashboards, and well-meaning distance. They come looking for metrics. She asks about memory. About grief. About who gets left off the map and for whom the work is for.

She brings with her a mind sharpened by Baldwin and bell hooks, a memory full of crowded classrooms and cafeteria tussles, a voice that doesn’t flinch when someone calls her “too passionate.” Her voice is still calm and steady, and when she uses it, people stop writing.

She speaks with the steadiness of someone who’s learned to breathe in rooms not built for her—and the reverence of a girl who once stepped around the “W,” knowing some things should never be trampled.

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

Key Themes:

• Culturally Rooted Education as a Social Determinant of Health

• Structural Racism in Education Systems

• First-Generation College Student Stress and Role Strain

• Invisible Curricula and Community-Based Knowledge

• Disparities in Educational Access as a Root Cause of Health Inequity

• Historical Trauma and Intergenerational Resilience

Health Outcomes:

• Improved mental health and self-worth

• Reduced chronic stress

• Increased resilience and coping skills

• Higher risk of anxiety and depression (for first-gen students)

• Lower educational attainment linked to poorer health

• Greater identity security and belonging

• Impact on intergenerational trauma (healing or harm)

  ---

Systemic Failures:

• Racialized Education Metrics

• Institutional Racism in Higher Education

• Economic Gatekeeping in Health Fields

• Stigmatizing Narratives about Black Schools

  ---

Community Assets and Strengths:

• Culturally Grounded Education

• Intergenerational Drive and Sacrifice

• Personal and Academic Resilience

• Liberatory Educational Spaces

Discussion/Reflection Questions for Practitioners:

1. In what ways do cultural identity and representation in education support health and well-being?

2. What are the emotional and mental health impacts of being a first-generation college student navigating cultural and familial expectations?

3. How do we recognize and support culturally grounded learning as a public health asset?

4. Where in our own institutions might we be perpetuating deficit-based narratives or gatekeeping access to the field?

   ©2025 La’Quana Williams, MPH · A Mercy in the Telling

   This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

   You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

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Brick Red follows the story of a woman navigating an unresolved miscarriage while living in Brackridge, a fog-wrapped coastal town marked by isolation, environmental unrest, and emotional silence. Through blood, silence, and memory, this story explores what it means to carry loss in a place that does not name it—and what it takes to begin finding your way back to yourself.

**Please note, this study contains themes that may prompt strong emotions for readers. Take care of yourself before, during, and after this read.

I. The Mistake

It began with a mistake.

The kind doctors don’t apologize for.

He walked in smiling, chart in hand. “Congratulations,” he said.

But she already knew.

The blood had come steady and bright, and the ache in her body was not new life, but leaving.

Still, she let herself hope.

Maybe the doctor was right. Maybe the pregnancy was holding on, nine weeks in and stubborn. She had carried a child before. Maybe she could carry again.

But no.

The congratulations faded beneath his gloves.

There was no heartbeat. There would be no baby.

II. The Waiting

The bleeding didn’t stop.

Days passed. Weeks.

They told her it would resolve on its own. That her body would know what to do.

But her body was confused.

Her body was trying to keep something that no longer wanted to be kept.

She bled through meetings.

Through dinner. Through bedtime stories with her son.

She bled while folding tiny clothes and checking her email.

She bled through her own silence.

The paperwork called it an abortion.

She had aborted before—once, by choice, long ago.

But this was not that.

This was something else. Something not chosen. Something not understood.

She returned to the doctor. They handed her pills.

“Take these,” they said.

“It will cause a spontaneous abortion.”

Go home.

Wait for the clot.

Just a cluster of cells, they said.

But she felt something still inside her—holding on.

Stubborn. Strong.

Like her.

III. The Place

They had moved far from home.

Too far.

To Brackridge, a peninsula town wrapped in ocean on three sides and fog on all four.

The mornings here smelled of salt.

Windows sweated brine.

The fog circled low, slow. At all times, but especially in summer.

There were Black folks in town, but barely. The kind you waved to from a distance. The kind afraid to spend too much time sidebaring with you because others might think they were playing favorites.

She missed her people. Missed the kind of familiarity that didn’t have to be earned.

She missed warmth.

Her husband had said the move was for peace.

But her peace didn’t feel like this.

Inland, past the ridge, sat the puff factory.

No agriculture, no fields—just smoke.

The factory loomed like an illness with no diagnosis, exhaling thick gray clouds day and night. Some folks blamed it for the town’s headaches, the nosebleeds, the way the sky seemed to hang lower each year. Perhaps now even death had come.

“Don’t nobody talk about what’s in that air,” her husband said once, eyes fixed on the morning sky. “You know them folks can change the weather patterns any which way they want to now. They control everything.”

He meant it.

He’d started showing her AI videos and doctored soundbites on social media between bites of toast. Proof, he said, of what was happening behind closed doors.

Meanwhile, she bled.

Meanwhile, she soaked through towels in the middle of the night.

Meanwhile, he studied the sky.

He noticed the clouds before he noticed her face.

IV. The Procedure

The clot never came.

The blood, once bright red, turned brick-red.

Thicker now. Sticky when it dried.

It stained her underwear, her sheets, her silence.

The doctors scheduled the D&C.

“If the cells keep multiplying, it could become cancerous,” they told her.

She nodded. Her body had betrayed her enough already.

She kissed her son goodbye at summer camp.

Held him longer than usual.

Tried not to let the fear show.

What if it was the last kiss?

At the hospital, they struggled to find a vein.

Too much bloodwork over too many weeks.

She floated above it all, tired and hollowed out.

When she woke, the doctor seemed proud.

“Just a small cluster,” he said. “We got it.”

He smiled again.

She didn’t.

They gave her Vicodin.

A heating pad.

Sent her home.

No one said the word grief.

V. The Count

At discharge, the nurse leaned in, voice lowered.

“Three pregnancies, one birth?”

She whispered it like a secret.

A fact on a form.

A history reduced to arithmetic.

Three lives. One child.

She wanted to ask:

Where do you record the ones that almost were?

Where do you write down the ones that fought to stay?

VI. The Memory

She would carry the memory like marrow—silent and unseen, but always inside.

Not a cluster. Not a clot.

A presence.

Something that had once chosen her, even if only for a little while.

And though the world would never name it, never chart it,

she would remember.

The brick red.

The stubborn holding on.

The quiet goodbye.

The antidepressants came after.

Said these would just be temporary.

Just enough to get her over the slump.

Some losses come in smoke. Others in blood. Either way, they stay, and salt the edges of a woman’s life.

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

Key Themes:

• Miscarriage and Medical Misclassification

• Black maternal mental health and emotional isolation

• Environmental health and community mistrust

• Displacement, loneliness, and cultural erasure

• Gendered silence and relationship strain

• Conspiracy, belief, and the need for story

• Grief as something unrecognized but carried

  ---

Health Outcomes:

• Prolonged physical trauma due to unresolved miscarriage

• Psychological impacts: depression, emotional blunting, anxiety

• Disrupted intimate partner relationships and caregiving balance

• Ongoing distrust of health systems

• Environmental stress (air quality, geographic displacement) affecting reproductive health

  ---

Systemic Failures:

• Clinical misdiagnosis and insensitivity in early pregnancy care

• Lack of emotional or trauma-informed support after reproductive loss

• No integration of mental health care in post-miscarriage treatment

• Racial isolation compounded by relocation and white-dominant social norms

• Environmental neglect and failure to address air quality in Black communities

• Public health systems’ inability to register or respond to grief as data

  ---

Discussion/Reflection Questions for Practitioners:

1. What are the consequences of misclassifying miscarriage as “abortion” in medical records and patient communication?

2. How does geographic displacement (e.g. moving to Brackridge) impact health, especially for Black women?

3. What role does conspiracy or belief play in coping with systemic harm?

4. How do clinical systems fail to address grief in reproductive care? What would trauma-informed care look like here?

5. What are the public health responsibilities around air quality in communities like the one near the puff factory?

6. How can narrative help us reimagine what counts as public health evidence?

7. Where do you see ancestry, silence, and remembrance working in this story—and how might they function as protective or healing forces?

   ©2025 La’Quana Williams, MPH · A Mercy in the Telling

   This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

   You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

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Overview:
This narrative case study explores environmental racism, historical trauma, and the brokenness of public health systems in rural Black communities. It follows Mira as she contemplates justice, memory, and the legacy of toxicity in her hometown, Hollow Creek.

Narrative:

The land remembered what the people tried to forget.

It held the footsteps of grandmothers who birthed babies on porches because the hospital turned them away, and the laughter of boys who never made it past seventeen. Clay held blood and sweat in equal measure, offering only silence as testimony.

They built a clinic near the old oak, the one with the rusted chain still looped like a warning. Called it a “wellness center,” though nobody ever got well.

What good is healing, Mira thought, if the wound is still open?

She stood on the red-dirt ridge, staring at the broken road that cut through Hollow Creek like a scar. The smell of rain, heavy and metallic, lingered.

Her grandmother used to say storms didn’t just come to wash things away. They came to help us remember.

Eli joined her, hands in his pockets, eyes scanning the horizon.

“You hear that?” he asked.

Mira cocked her head. “What, the sirens?”

“You gotta stop just listening with your ears,” he said. “There’s a hum. Like the ground’s got something it wants to say. Granny taught us that, remember?”

She shook her head. “All I ever hear are sirens.”

He sighed, exasperated. “I heard Hollow Creek finally got a grant for sidewalks. Folks been askin’ about that chemical plant forever, but I guess they more worried about curb appeal than root-work.”

He glanced at her. “Ain’t that what y’all been doin’ all that outreach for with them nonprofits? Tryin’ to organize so we can have what them folks got downtown?”

“Absolutely not,” said Mira. “We’ve been organizing for what we should’ve had all along. And for them to take accountability for everything they left us without all this time.”

She kicked at the dirt. “The problem is, this equity work is slow,” she muttered. “Like honey in winter.”

Eli grinned. “You ever try to eat frozen honey? Don’t thaw just ‘cause the sun comes out.”

She looked at him sideways. “You always gotta ruin the metaphor?”

He smirked. “Just tellin’ the truth.”

Below them, children played near the chemical plant. “The Puff Factory,” they called it. Their laughter rose with the smoke.

“Ain’t no way our babies should have to grow up like that,” Eli said.

“They don’t grow up,” Mira replied. “Not all of ‘em. And even when they do, the effects of all this mess catch up to ‘em before they even hit thirty.”

He didn’t argue. Even he struggled with asthma and migraines from time to time. He thought these were just normal issues that came with age. Mira said they weren’t. That asthma itself wasn’t just something he got from Daddy. She said it was preventable.

The air smelled like rain, but sharper. Like metal. Or memory.

Mira crouched to touch the soil. “You really think the land is humming? Feels more like it’s holding its breath to me.”

Eli nodded. “Maybe it’s just waitin’ on you to remember.”

The truth was, something was shifting. Beneath the grief, under the weight of inherited hunger, the land was humming.

Not a song of suffering, but of fire.

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

Key Themes:

• Environmental justice

• Structural racism

• Medical neglect, racism, and exclusion

• Rural health disparities

• Intergenerational trauma

• Disillusionment with institutional solutions

Health Outcomes

• High rates of asthma and other chronic illnesses

• Premature mortality / shortened life expectancy

• Mental health impacts

• Generational trauma passed through place and body

Systemic Failures:

• Redlining and racist zoning policies

• Medical racism and hospital exclusion

• Resource misallocation in public health

• Grant inequity and superficial investment strategies

Reflection Questions for Practitioners:

If you work in public health, community organizing, or policy:

Take a moment with these questions. Feel free to use them for personal reflection, or open dialogue with others.

1. What does healing mean when the conditions causing the harm are still present?

2. What role does public health play in deciding what gets fixed — and who gets ignored?

3. In your own work, where might you be prioritizing visibility or optics over actual justice?

4. What stories has the land in your community been forced to hold: Who gets to speak about them?

©2025 La’Quana Williams, MPH · A Mercy in the Telling

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

You are welcome to share or adapt this work for educational and community purposes, with clear attribution to the author. Commercial use requires written permission. Any adaptations must be shared under the same license.

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I’m La’Quana, a public health practitioner and adjunct lecturer by day, and a lifelong, voracious reader of literary fiction at heart (think Toni Morrison, Zora Neale Hurston, Brit Bennett, and Jesmyn Ward). Their work has helped me understand that storytelling can reveal breaks in systems, disrupt assumptions, and move people toward justice.

I created this space because I believe public health needs new forms of evidence.

What you’ll find here are literary case studies in public health—drawn from both lived experience and imagination—that sit at the intersection of public health, racial justice, and (re)memory. Some come from my own life. Others are stitched together from the places and people I carry with me.

A Mercy in the Telling is not just a space for storytelling; it is a challenge to the field. Public health has long leaned on data, but data alone cannot carry the full weight of harm or healing. Narrative can. And it must.

These case studies are evidence: they linger, they teach, and they push us to see, ask better questions, and respond differently.

I’m so glad you’re here.

If this resonates, feel free to share it. And if you haven’t already, hit Subscribe to stay connected as this space unfolds.

With love, La’Quana “Q”.

“You think because you understand one, you must also understand two, because one and one make two. But you must also understand ‘and.’”

— Sufi proverb

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