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In a conversation with Milbank Memorial Fund president Christopher Koller, Fatmata Williams, director of medical administration at the Connecticut Department of Social Services Division of Health Services, reflects on how her background influenced and inspired her public service. A 2021–2022 participant in Milbank’s Emerging Leader Program, Williams discusses her shock at the racism she experienced upon moving to the United States — and how she works with people with different perspectives to improve health equity. This Q&A is part of in a series on policymaker “origin stories.” Please see a companion interview with Utah State Senator Fred Baldwin.
I was born and grew up in Sierra Leone, a small country in West Africa. I grew up very privileged because my dad was the third in command in the Sierra Leone armed forces. However, even as a child, I gravitated toward people who needed help. And even then, I questioned our system in Sierra Leone as favoring some people over others.
Things changed for me in 1991 because we had a civil war in the country, and my dad was framed because of his high position in the Sierra Leone armed forces. We had to flee for the United States. When I arrived in the United States after completing a year-and-a-half at the University of Sierra Leone, I had two profound realizations that showed me that I needed to get all the tools and skills necessary to advocate and help people but also to help myself. Number one, coming in as a political asylum seeker, I realized I was nobody. And then the second thing I realized was that I was a Black person in America. I was no longer the Madingo girl from Sierra Leone. I had been part of a homogenous group, because most times in Sierra Leone, you are identified by your ethnic origin, and I am a Madingo.
It was very evident to me that every single outcome I would achieve in America would be predicated on this thing called race. It pushed me to learn the system, attend nursing school, and start working as a registered nurse with underserved people in the United States. And that’s how I moved to where I am today, working for Medicaid.
Never. In Connecticut, you’re working as a home health nurse, you go to collect your paycheck, and they look through the nursing assistant pile and cannot find your paycheck until you cue them that it may be in the registered nurses’ pile. It was 1999 — you couldn’t have been a nurse, you are Black. You’re pregnant, and no one is listening to you, and you almost lose your baby and your life in a hospital. Even in nursing school, you see how differently you are treated, and don’t have access to opportunities because a patient doesn’t want you; after all you are Black.
Because I wasn’t born into this, it shocked my system. And then it put me into “fight or flight.” And all I have done since that time is fight, which is why I am a passionate and ardent advocate for underserved people. I know how challenging it is to navigate the systems. When you add race on top of it, the outcomes are even worse. So that’s why I always say there’s no health equity without race equity.
I don’t come from a place of judgment. I come from a place of understanding. I try to help you understand that you may not be aware, people are still experiencing racism, including me. So how can you help? I know we all have the same goal: to improve people’s lives, not just those of one group. We are serving people in Connecticut of different races, ethnicities, sexual orientations, gender identities, physical, and mental abilities. It is essential to have these conversations.
Prior to 2015, we had barriers to specific treatments for people who are transgender. For instance, because of our hormone treatment coverage policy, the claims processing system would only pay claims for certain hormones based on the beneficiary’s gender. Several colleagues were uncomfortable with conversations [about transgender people]. It took a lot of discussion and education to convince these colleagues to eliminate treatment barriers for individuals who are transgender. In 2015, we had the buy-in to ensure that people could access all covered health services regardless of gender.
It has gotten better over time. I will not underestimate the impact of Covid and the killing of George Floyd on race relations. I still believe that where you are situated is where you are situated, but we can have conversations about health disparities more easily, and I can bring the data forward if there is pushback. A while back I would hesitate before pointing something out. I would think: Is this the right thing to say? Is this the right forum to say it? But I don’t believe that I have the luxury of time. I feel the urgency to address the disparities in health outcomes, especially for historically marginalized people.
When I did clinical practice, I saw many things in the community that triggered me. I did clinical work in hospital settings, and then moved into home care. Home care was the area where I saw the most disparities. I worked in affluent and poor parts of Connecticut. Sometimes I knew that all I was doing with a particular patient was purely Band-Aid, which put me in a state of moral distress. Lifting that person out of that environment is what would have been needed to improve their health outcomes. I realized that I wanted to make large scale policy changes because that would truly impact people. This realization moved me toward working for Medicaid. And I do not regret it because I have been involved in developing equitable health policies that are impacting populations, not just one individual at a time. I hope to continue doing this work for a long time to improve people’s lives, change the environment, improve systems, and eliminate disparities.
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