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The “race awakening” brought about by the murder of George Floyd last year and the disparities in the Covid-19 impact between whites and BAME communities has, for some, spotlighted how Black people are let down by and systematically excluded from society’s institutions.
One I find particularly disturbing is healthcare. Racism and the historical medical mistreatment of Black bodies have upheld ideas of Blackness as not only culturally other but humanly other altogether.
Black people experience higher levels of neglect and mistreatment by medical professionals, are haunted by erroneous anatomical beliefs fabricated by racists that still find their way into medical practice today, and, to make this game even more despicable, are put at increased health risk by the very same racism that makes seeking out healthcare so much harder for us.Black people know this, and medicine’s bright white history has left many mistrustful. So many of us are always ready for the potential awkwardness from the receptionist when we ask “do you have any Black doctors available?”
It shouldn’t be surprising that Black folks face discrimination and neglect when it comes to health services. The history of western medicine is white, male and riddled with atrocities committed on Black bodies. And the legacy of this history, as with all institutions in society, is still very much alive, still perpetuating the racism that’s been inherent in medicine since the colonisers colonised. There isn’t sufficient knowledge among healthcare workers in diseases like sickle cell, which predominantly affects those of African and Caribbean descent.
Medical schools aren’t training doctors to know how some illnesses present in people with Black skin, with some doctors going through their entire training without seeing examples of how common skin conditions like eczema appear on non-white skin.
One that’s been headlining recently is how pulse oximeters are more likely to miss low levels of oxygen in people with Black skin, resulting in Black patients being sent home when they should be hospitalised. “Historically medical education was designed and written by white middle-class men, and so there is an inherent racism in medicine that means it exists to serve white patients above all others,” leaving Black patients subjected to higher levels of neglect, mistreatment and death.
A recent and tragic case involving a sickle cell patient is that of Evan Smith, who died after calling 999 from inside the hospital when he was denied oxygen after being told his blood saturation levels were healthy. The coroner ruled that the cause of Smith’s death was not receiving “a timely exchange transfusion”. A significant factor in the delay was “a lack of understanding of sickle cell disease in the medical and nursing staff looking after Mr Smith.” An alarming finding was that “nurses did not have specific training in managing sickle cell disease, despite serving an area with a large African and Caribbean community.” The coroner did not make a ruling of neglect.
There was a case at my local hospital, also in an area with a large population of African and Caribbean people, where a woman took herself with her new-born to A&E and was sent home by hospital staff on a bus. It turned out she had developed sepsis a week after giving birth. A Black nurse who later heard about this said she immediately knew the woman was Black because such treatment was so commonplace.
Black people are mistreated and under-served in healthcare. This is a direct result of medicine’s racist history, for which not enough has been done to undo, and the subsequent implicit biases held by medical professionals and healthcare workers. As recently as the 1970s there were medical text books that stated Black people have a higher pain threshold than whites.
And as recently as 2016 a study from the United States found that many medical students “believed that black people’s nerve endings are less sensitive than white people and that black people’s blood coagulates quicker.”
There have been other studies showing that “black patients are often prescribed less pain relief than other people, despite having the same conditions, and that applies to children too.” There are countless cases of Black patients being denied the care they need and are entitled to or having to fight a lot harder to receive it.
It was hard not to think about my own experiences and those of people close to me as I went through these stories of mistreatment and learnt even more about how deeply race impacted medicine and healthcare provision. When I hear that there are medical workers out there who think our blood coagulates quicker I can’t help wonder about a time I went to A&E and instead of leaving with stitches I got a dodgy tape up that had reopened by the time I got home. I had to buy my own supplies and take care of the dressing myself.
When I hear that our pain is perceived differently I can’t help think about the time when a doctor wouldn’t prescribe me pain medication for migraines. Maybe the hospital staff there were bad at their jobs, maybe it was an accident. Maybe that doctor genuinely thought I’d be fine if I watched my caffeine intake and tried to take paracetamol as early on as possible. The fact is I can’t not wonder if race played a part in these events. Especially when stories of Black people being treated differently are so widespread and seen in all areas of healthcare.
An area that’s been receiving particular attention recently, also with a long history of neglecting Black people, is mental health care. In school, I saw white students getting access to services and being treated with more sympathy than my Black peers and myself. Even once in the system I’ve had friends report also feeling gaslit and treated with blatant disregard at points. Medication reviews feel one sided, symptoms are questioned and ignored, problematic behaviours are minimised.
Race can even make it hard to take the first steps in seeking out mental health services. Or, rather, the lack of provision within mental health services of sufficient resources for Black patients, such as POC therapists, can make this hard. “I would take anything right now not to feel the way that I did last night because it was awful,” a friend said to me, “and I know that I need therapy but I am not willing to go to a white therapist at this point in time.” Similarly to how a female assault victim would rather see a female therapist, a Black person who has been psychologically impacted by the frequent traumas of racism would rather see a Black therapist to discuss these things. The fact that healthcare services don’t think about this shows they don’t think about Black patients and their experiences.
I know these are services that are already strained but when Blackness is such a common denominator among those let down by them it’s impossible not to look at race as part of the reason for these failings. The recent deaths of Olisa Odukwe and Richard Okorogheye serve as yet more tragic reminders that while Black folks are let down in all areas of healthcare, mental health is one which seems to particularly fail and exclude us time and time again. In the words of @lookingformothermax, “young Black people’s lives should not be cut short before they are afforded access to, and inclusivity in facilities and services… the face of mental health advocacy and campaigning should not and cannot only be white middle-class people.”
The health disparities highlighted by Covid-19 won’t be going away once the pandemic is over (nor did they only come to exist when it started), and if negative health outcomes resulting from racial bias aren’t spoken about they never will. We need more research into how race impacts health outcomes. Data needs to be gathered so problems and solutions can be identified. As long as the experiences of Black people are ignored and gaslit by society and by documents like the Sewell Report, they’ll be ignored and gaslit by our doctors.
And for those who lack certain levels of humanity and need these issues framed in the context of how wider society is affected for them to mean anything to you, vaccine hesitancy among BAME communities is a direct result of the mistrust these groups have of the medical establishment because of its racist past and present. It might not make sense to some why people would trust their barber or pastor over the CDC, but would you trust someone who time and time again has demonstrated that they don’t have your best interests at heart?