By Tawana Mazhude

In 2020 the year of Covid-19, Australian and South American bushfires, global protests against police brutality and Brexit we have become more aware of the impact of racism. This movement of consciousness has highlighted the ways that racism impacts the life of ethnic minorities including in education, policing, beauty standards and healthcare. 

In order to fully understand the impact of racism in healthcare today we must first acknowledge its history and where it began. 

The history 

In 1845-1949 the “father of gynecology” J. Marion Sims was known to perform unethical experimental gynecologic procedures on enslaved black women. He perfected his gynecologic techniques such as the medical cure for vesicovaginal fistulas and created the ‘Sims’ speculum (still used today). He practiced without consent or anesthesia on enslaved black and irish women due to the perception that these women were more able to tolerate pain.

Today, this assumption that black people are less likely to feel pain is still a problem faced in healthcare. Decades of research attest to the fact that black patients are systematically under treated for pain. A survey was conducted of 222 white medical students and residents in 2016 which found a shocking majority agreed with statements such as “Black people’s nerve endings are less sensitive than white people’s nerve endings” and other falsehoods such as “black people have thicker skin than white people”. 

Although these experimental gynecologic procedures were performed on black people, black women are 4 times more likely to experience pregnancy related death and 5 times more likely to experience complications in comparison to their white counterparts. With high profile black women such as Serena Williams and Beyonce both having spoken out about their troubles experienced during childbirth. During this 2020 pandemic it is noted that the rate of Covid-relat­ed deaths in Black people is four times higher than the rate of white Covid-19 deaths; and People of Bangladeshi and Pakistani, Indian, and Mixed ethnicities also had statistically significant raised odds of death compared with those of White ethnicity.

The ‘Black’ ethnic group makes up only 3.5% of England’s population, however this group represents 5.8 percent of Covid-19 deaths. Which means the share of deaths is 66 percent higher than the share of the general population. In the white population their share of deaths is 14% lower than that of the population.  While risk of mortality from COVID-19 across ethnic groups may be related to socio-economic factors as well as a person’s medical history, we must also consider racial bias a factor. A systemic factor which causes great divides in care across all aspects of medicine. 

What we can do? 

The first thing we as clinicians and students must do is to identify and  acknowledge the differences in how certain groups are treated in order to eliminate these racial biases. 

An excellent example of this is the work done by Malone Mukwende a 2nd year medical student at UCL who identified that most pictures of clinical signs in textbooks were presented on white skin. He has now co written a book with Margot Turner and Peter Tamony called “Mind the gap” which has the goal of providing images of all skin tones which once implemented into all medical textbooks will allow for better care of all patients. 

This is what he had to say in his interview with St George’s University: “The aim of this booklet is to educate on the importance of recognising that certain clinical signs do not present the same on darker skin. This is something which is not commonly practiced in medical textbooks as there is a ‘white skin bias’. 

“The booklet addresses many issues that have been further exacerbated during the Covid-19 pandemic, such as families being asked if potential Covid patients are ‘pale’ or if their lips ‘turned blue’. These are not useful descriptors for a black patient and, as a result, their care is compromised from the first point of contact.”

In practice, those with a darker complexion are 10-30% more likely to present with more severe complications of Lyme disease as the main pathognomic sign erythema migrans does not appear as a “bullseye” rash and results in clinicians not identifying the disease till it has progressed much further. 

To conclude, the goal is to eradicate these disparities in outcome based on skin color. In order to achieve this we must unlearn falsehoods suggesting that any skin colour is more or less, we must also acknowledge the differences that exist between different ethnicities but this should never compromise the care we give our patients.

References

https://www.physio-pedia.com/Addison%27s_Disease

https://www.sgul.ac.uk/news/mind-the-gap-a-handbook-of-clinical-signs-on-black-and-brown-skin

https://www.medicalhistorytour.com/missives/2017/10/13/zfte1jw4ryya8zjqqvmq3njux7no66

https://inthesetimes.com/article/healthcare-bias-racism-discrimination-black-health-disparity

https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronavirusrelateddeathsbyethnicgroupenglandandwales/2march2020to10april2020#:~:text=In%20our%20data%2C%20the%20proportion,Black%20ethnicity%20made%20up%205.7%25.

https://www.google.com/amp/s/www.statista.com/chart/amp/21480/england-covid-19-deaths-by-ethnicity/

 First seen in the Medical University of Sofia student magazine

More on Race & Nationality

More from Guest Writers

Join the Sips Tea fam