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“Mi jus si a docta who fava yu bad!” my grandma said from the hospital bed, her eyes alight with excitement.
I smiled widely while exclaiming, “Really! What did she look like?”.
For those who don’t speak Patois, what my Grandma said was that she had just seen a doctor who really looked like me. It’s a moment I’ll never forget. Not just because it was one of the last conversations I ever had with her, but because it was also the moment I realised that I had never seen a black female doctor in my entire life. I was 15 years old at that point and my desire to be a paediatric consultant had already been percolating in my brain since I was 8. Armed with the age-old adage of the black community that I had to “work twice as hard as my white peers to be thought half as good”, I had already set about getting hospital placements, work experience, you name it! If it was medical, I was there! So, it definitely wasn’t a lack of exposure that had caused this blind spot when it came to the medical workforce. It was a lack of black female doctors. And my Grandma knew this. She was a quiet woman who wouldn’t speak unless she needed to, and she knew at that moment, with the little time we had left together, that I needed to hear that there were people like me doing the things I dreamed of. Even if I couldn’t see it.
I was 26 years old when I first saw a black female doctor. Let that sink in for a minute. I had to wait over a decade from that precious moment with my Grandma before I saw a doctor who looked like me. Before I saw a proud, dark skinned black women stand in front of a group of medical students and introduce herself as a paediatric endocrinologist. Dwell on that fact. Dwell on the feelings of otherness, tokenism and solitude that come both from within you and around you as a result of being the only person in a space who looks like you. Focus on the metamorphosis, the adaptation and the homogenising that you must do in order to try and be accepted, to try and look like the doctors you see before you and the colleagues you see around you. Then, imagine the power, liberation and satisfaction that comes from looking up and being faced with someone who reflects you. You see your history in their skin, hear your family in their voice, feel your pride swell at their success. You know now that your story, your struggles, your achievements, they are all valid and they all belong. You are finally given the right to take up the space that you so justly deserve. And this is why representation in medicine is of the utmost importance. Its ramifications have the ability to completely change people's views of themselves and their aspirations, and by virtue of this it also has the power to drastically alter the cultural landscape of clinical medicine, and this is needed now more than ever.
Evidence of this necessity for change comes in the form of a timely but heart-breaking research paper by Greenwood et al 2020. The article shows that black infants are two times more likely to survive when treated by black physicians as opposed to white physicians, and that this difference remains significant when variables such as patient complexity, and socio-economic status are taken in to account(1). This mirrors findings from the 2018 systematic review performed by Shen et al which found that black patients experienced better communication when they were engaging with black doctors as opposed to white doctors(2). This highlights the desperate need for a cultural revolution in medicine. One that aims to ensure that medical schools are a place where all doctors feel they can belong whilst being their true, authentic self. One that aims to increase the numbers of black clinicians in the medical workforce whilst empowering those already it. One that aims to address the conscious and subconscious biases of non-black doctors to ensure that health equity is achieved, because the struggle for equality cannot be placed on the shoulders of black physicians alone. As doctors we have the honour of safeguarding one of the most precious things in this world, a person’s life. The way in which we value it, treasure it and care for it should not be determined by the colour of the person’s skin.
I know that the standard of care my Grandma received throughout her life was suboptimal. I know that this was based on the beautiful dark tone of her skin, the gloriously colourful Patois she used and her reflectively taciturn demeanour. All of which were things I loved so much about her, but when viewed through the eyes of white healthcare professionals they were qualities that made her “unintelligent” and “unwilling to engage with care”. I wasn’t able to tell my Grandma that I had been accepted to one of the best medical schools in the country. I know it wouldn’t have changed her love for me or how proud she was of me. But I just always wanted her to know that her words had power. That whenever I think of our conversation in that little side room at Queen Elizabeth Hospital I am filled with both sadness and joy. Sadness at the fact that she is not here to see the changing demographic of our world, the black women who are taking control of their own destiny, her 15-year-old granddaughter who is now that black doctor inspiring another generation. But also joy in the fact that I had a Grandma who understood the power of representation, the power of seeing yourself reflected in others and the power that we have to make a change in someone’s life just by being us.
References
1. Greenwood BN, Hardeman RR, Huang L, Sojourner A. Physician–patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci. August 2020:201913405. doi:10.1073/pnas.1913405117
2. Shen MJ, Peterson EB, Costas-Muñiz R, et al. The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature. J racial Ethn Heal disparities. 2018;5(1):117-140. doi:10.1007/s40615-017-0350-4