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Racism in healthcare: On the receiving end

A curious dissection or reflection of sorts following one of 'those' racist experiences. I hope it'll help shed some light on some of the emotions and thoughts associated with these experiences within a healthcare setting. If it helps one other person, then it has served its purpose.

Early encounters of racism in Medical School

The first time I experienced racism in the profession wasn't from patients. Nope. It was from my peers. It was actually on my first day in Medical School. I had the misfortune of being within earshot of a discussion about my inclusion into the School of Medicine. They didn't think it was based on merit but through positive discrimination. I should add I was the only black student in my cohort.

A few weeks later we started going on rounds with our clinical educators/consultants. During one of those clinical sessions on the ward, I vividly recall one of the consultants teaching us that we should never examine black peoples' feet as we may 'catch a disease'. It left me contemplating my black feet, which were firmly attached to my black body.

The worst thing about these moments and the subsequent 'little' ones which, would follow was that no one spoke up. There was no dissent. Everyone nodded along and took notes. A few people laughed. I doubt they even recall these moments. Yet, this was to become my template for the next 4 years. The odd racist comment, nod, laugh, occasional jotting of said points and move it along. No one stood up. Admittedly, not even me. Sometimes when I'm feeling more 'racially resilient', I feel ashamed for failing to stand up for myself. Then I remember I was a black African, 1st generation female immigrant with a 'Kenyan-ish, 'African-ish' British-ish, Other-ish accent. Yeah...I wasn't about to open my mouth. I knew better by this stage in my life.

The promise

Naturally, I made a promise to myself after the first handful of encounters. 'I would try to be as invisible as possible in those spaces'. It was the only way I could think of to survive.

That is exactly what I did. I tried my best to keep my head down and just survive. I was scared most of the time. Public spaces were particularly difficult - buses, trains, malls... Even shopping for basic necessities such as food was tricky. I went as early or late as I could - fewer people meant safer. I attended a handful socials in the 4 years I was there.

To survive, I had to lose my voice. Then, I lost as much of myself as I could because ironically, blending with the walls was impossible. So, it's not entirely surprising that I hated every minute of medical school. My grades took a to hit. The clinical rotations in the last year were particularly difficult. We rotated every few weeks, through different towns, having to live there during those periods. If I didn't feel safe in med school, I felt even more unsafe and unanchored in the other towns. I felt like the only black person within miles. I suspect this was not the case, but that's what it felt like.

TO THIS DAY, I still have the urge to shrink and blend with the walls whenever I step into healthcare spaces especially clinical meetings, healthcare education seminars and conferences. Any spaces with my peers in it. I'll admit that after new racist moments in the healthcare setting, I'm so triggered that for the next few weeks or months, I'll avoid certain spaces. It is the only way I know to feel safe, and it has served me well over the years.

Admittedly, things are a better of course. I have a handful of people in my current workplace, who've showed me through their actions what ANTI-racist allies look like. It's different from ambivalent allies. That's a thing. Having my allies has helped me re-discover a little bit of what I voice and slowly by slowly I'm getting some pieces of me back. This is one of the reasons I can talk and write about this now... this year.

The encounter

'I didn't see it coming'. Sometimes you do. Sometimes people do and say exactly what you think they're going to.

Not this time. I didn't expect it from this particular patient. I'd had previous consults with them.

The Covert Racism started when my Caucasian colleague stepped into the room. It caught me completely off guard. When the patient left the consultation room, and my colleague called it out for what it was...validating gave me the permission to face it. On reflection, it wasn't the first time I felt like I needed validation to callout racism in healthcare when directed at me. I had allowed it to become the norm.

This 'ugly' experience got to me in a way that, still confounds me. I've experienced my fair share of racism in healthcare both as a professional and patient. I don't scare easy, but this particular experience got under my skin.

*It is also not how I experience ALL forms of racism. Most of the time, I laugh things off, take the experiences home to my parents and siblings, some friends.

Shock and Denial. This emotion was the easiest to recognise. I felt completely numb for the rest of the day after that incident. 'It can't be happening' and it sure as hell not happening to me - again. I was trying to un-experience or re-write the narrative to something more palatable such as overly sensitive, it's all in my head, I misunderstood etc.

Anxiety and Fear. Fear associated with feeling deeply vulnerable and unsafe in that moment and in the days which followed. If it had been possible to peel of my skin during that consultation for some relief and return to it later... I would've done it. I sought refuge in my medical school survival techniques.

Shame. I don't fully understand this emotion, but it was present. It clung to my skin. In retrospect, that shame is often present after these encounters. Then, I feel ashamed for feeling the shame. It's complex and mind-boggling to me.

Self-isolating. With the anxiety, fear and shame, there was only one way forward retreat and I swallow the emotions and the tears. I didn't feel anyone would get it. I didn't think they'd be enraged by it too. So retreated into myself.

* I knew I'd hear many versions of sorrys...' sorry this happened to you'... But I would also hear '...are you sure you're not being sensitive? '...'could you have misinterpreted the situation/words/actions'....'they didn't mean it, or they didn't mean it like that'..'. I've known them for ever and it's unlike them'.... maybe they're just having a bad day .... it's just their age...'or eyes...their generation or culture....

Sad. Like all humans who call this planet our home, I too have a right to exist and feel safe. Yet, these experiences serve as a stark reminder that I'm not safe or as safe because of my skin colour. Not to mention, who wants to carry the emotional/psychological scars/baggage of these racist experiences. Not me.

After the experience

Typically, if an experience has gotten to me, I'll try where possible to lean on my colleagues a bit more. I'll often mention, I've had a challenging consult and ask if they mind anchoring me. Then I'll crack on with it. Why??? because existing in certain spaces in this world means one is often taught to master the art of silence. One has to know when NOT to speak. I mastered the art when I was about 14 or 15 years old and became better at it in medical school. It's almost instinctual now.

No room at the inn

This time there was no room at the inn. None. All the experiences that'd swallowed over the years flew back out. I sat down in my consultation room the following morning and sobbed. I tried to pull myself together. I sobbed.

The Allies

At some point during the sobs, I discovered The Allies. Or rather, they came to my aid in the most human, compassionate and practical ways. Experiencing them in action was one of the best things that came out of this experience. So, in many ways I'm grateful there was no more room at the inn for my racist experiences. The sobbing set into motion a series of events that led to this discovery. All I did was sent short message to one of my colleagues and with them came a little team of 7 - 8 people who rallied around me.

What I found helpful

Time out. They understood better than I could in that moment, that I could not safely (emotionally and psychologically) continue in the consultation room where said experience had occurred. They insisted, that I power down and accompanied me a place of safety. There was something about this moment that made me feel more seen, understood and embraced, in a way that was novel to me. They understood what I was not able to verbalise.

Privacy. I was allowed the privacy I needed both on that 'sobbing' day and in the days that followed. I was supported and nursed back to my consultation room seat. It's taken about 10-12 weeks to feel like my old self. I know this because my anxiety became a real issue during this period and has only recently settled.

Action and words. An appropriate message was sent from the organisation in solidarity. They didn't try to explain away the experience. They didn't add to my shame or make feel guilty/weaker. They definitely didn't try to explain the experience to me.

This opened up space for compassionate conversations of understanding and learning from each other. One of the most enlightening moments for me came when I was asked, 'why didn't you leave the room or ask them to leave the consultation room? How could you just sit there and endure that type of abuse?'

'What I said was that as a black African female healthcare professional, I don't feel I have the agency/power/social currency. I have to tread lightly.... It would've better for me to have been physically assaulted in that consultation room than being racially abused. People, especially 'ambivalent allies' seem to understand and better support people who've been physically assaulted '.

The choice

Racism has no place in healthcare or our world. None of us has a say to whom, how or where we're born.

But we ALL, individually and collectively, have a CHOICE when it comes to racism. Antiracism is a choice. Ambivalence is a choice. Silence is a choice.

In sharing my story despite feeling really vulnerable doing so, I want to think I'm making a different choice. I refuse to be complicit with my silence. I'll try to speak up more...especially when I'm scared. Admittedly, it's easier with allies. I hope it makes someone who is in the thick of it, feel less alone.

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