There is no question that 2020 has been a big year for Global Health. However, this isn’t just because of COVID-19. The Black Lives Matter protests that began after the murder of George Floyd in May 2020 were the largest protests in United States history and led to many conversations on how structural racism impacts Black lives, including their health.

Our guest in today’s interview is Dr. Adwoa Danso. Dr. Danso is a GP and runs The Clinic Diaries – a social media platform that discusses health and clinical issues, and where she has recently been using this space to be vocal on BLM and COVID-19. Dr. Danso is also the Executive Officer of the Ghana Doctors and Dentists Association UK as well as being the resident doctor hosting ‘The Medical Show’ on GN Radio, a radio station for Britain’s Ghanaian community, and she is also a graduate of Barts and The London School of Medicine and Dentistry. 

We sat down with Dr. Danso to reflect on the past few months, and her experiences in the NHS and at Barts and The London.

Do you think racism is a public health crisis?

Health inequalities have existed for several decades and are well known to negatively impact health. However, when we look more closely at the causes we come back to racism. Housing, the criminal justice, health systems and much more are all built on the structures of racism.

Why do you think more people from BAME backgrounds are dying of coronavirus? - Follow Up - Is this the reason why a majority of the healthcare workers that unfortunately died from coronavirus were also from BAME backgrounds?

There are many different reasons why these groups are more at risk.The report ‘Beyond the data: Understanding the impact of COVID-19 on BAME groups’ goes some way to exploring these reasons. A significant number of NHS workers are of BAME origin and as a result have greater exposure than the general population. There are other reasons including socioeconomic and pre-existing conditions such as diabetes and hypertension which are more prevalent in these populations.

There are more serious factors including racial bias and institutional racism. We know that BAME individuals within the NHS are less likely to be promoted compared with their white counterparts. This may affect pay, so in order to make the equivalent pay, one may choose to work longer hours and undertake less desirable shifts such as those during unsociable hours.

The BMA identified that BAME groups are twice as likely not to complain about safety in the workplace. Reasons for this can include fear of being disciplined. During this pandemic we are aware of reported issues surrounding PPE. BAME workers may find it challenging to speak out. Bullying and harassment are unfortunately relatively high within this group.

A study of Black women in the US found that stress from frequent racist encounters was associated with chronic low-grade inflammation, are there any other ways racism clinically impacts Black women?

There are other studies which have looked at pain perception of Black people. A study in the US, found that half of first and second year medical students believed Black people had thicker skin than white people and perceived that Black people experienced less pain than white people. I strongly suspect that this may be a contributing factor in more recent studies in the UK. We have recently seen that Black women are five times more likely to die in childbirth compared to their white counterparts. It is these statistics and studies that go some way in cementing the distrust of the health system that already exist in some of these communities.

What should the NHS do to reduce structural racism within their hospitals?

We need to create an environment where NHS workers and users are able to raise concerns freely without fear of being reprimanded or targeted. We must ensure that those in senior and educational positions know how to respond to grievances in a sensitive appropriate manner and not be dismissive. A diverse workforce is essential in order to provide the best care.

Have you experienced any racism working as a GP in the UK?

Sadly as a GP I have experienced racism within the NHS, both overt racism and more subtle micro-aggressions. I had experienced racism from patients but more worryingly, early on as a doctor I had been trained and worked with overtly racist clinicians. We must first accept that racism exists within the NHS before we can start to dismantle structural racism.

How can healthcare professionals be an ally to their Black colleagues within the NHS?

Healthcare professionals must feel empowered to speak out. The key to empowerment is education. Do not rely on Black healthcare professionals to educate, it is the individual‘s responsibility. Colleagues should try and understand the unique challenges and hardships black colleagues face without centring the narrative on yourself. I have personally been in situations where I wished my colleagues had spoken out and voiced support. Being silent, is being implicit. Be actively anti-racist.

Do you believe that Barts and The London Medical School has a structural racism problem and were you ever subjected to racism while studying at the medical school?

I definitely experienced racism within medical school but it wasn’t as apparent and overt as when I started work as a doctor. I think it all starts from medical school and perhaps earlier though. As a Black student you have to work 10 times harder for the same opportunities. It’s a very difficult environment to speak out against unfair treatment, especially as a Black medical student.

Thank you so much to Dr Danso for sharing her reflections over the past few months and her experiences. If you would like to learn more about Adwoa’s social media platform, The Clinic Diaries, you can find her @TheClinicDiaries on Instagram.