As a British born Bame doctor, I have lost count of the number of times a patient’s opening line to me has been: “Are you English?”, “I’m not seeing a doctor unless they’re British” or “were you born in this country?” So many times in fact, if I had a penny for every comment, I’d probably have enough to fund PPE for a significantly-sized NHS Trust.
A few days ago, I learnt that all of the first 10 doctors and most of the nursing staff that had sadly passed away from Covid-19 were Bame. What followed was an eruption on airwaves, social media and news pieces on the value of “the immigrant” in Britain.
But this is not solely a question about immigrants within the healthcare industry. Not all those from Bame backgrounds are immigrants, a fact that many media outlets seem to have forgotten when reporting the statistics. In fact, over 40 per cent of all newly graduating doctors from UK medical schools last year identified as an ethnic minority.
While our over-representation in healthcare and increased health risk factors have been suggested as an explanation for the disproportionate deaths, the reality appears more complex. From observation, retired doctors returning to the NHS have been predominately from Bame backgrounds. Many returning are not young and with multiple comorbidities thrown into the line of fire (without any prior risk assessment or thought process into how to deploy and protect them appropriately), a failure of strategy and leadership from our government has resulted in negligence.
Socioeconomic inequalities have been cited as another reason – but it does not explain why more Bame doctors are dying. Perhaps there is another inequality at play here – one of workplace culture.
Are we as a community inherently more risk-averse? Or is it actually that we are expected to do more? In my career, it’s been the latter. Up until last week, I had never called in sick to work; I once even worked an entire weekend with pneumonia. It took a pandemic for me to take my symptoms seriously.
Instead of action or widespread uproar, we’ve taken to simply applauding our colleagues posthumously
There is evidence from the BMA and GMC that Bame doctors are much less likely to complain about issues regarding safety born from a concern of having to face recriminations or reprisals in comparison to their white counterparts. Early in my career, I once considered reporting a colleague for ongoing derogatory racial comments. I was met with the advice of “put up or shut up unless you want the problem you have about them to be turned into a problem about you”.
I have Bame colleagues in both hospital and community settings who are doing just that – “putting up and shutting up”; fearful for their own safety without adequate PPE but equally fearful of the repercussions of speaking out.
The medical profession is certainly no stranger to discrimination, a GMC-commissioned independent report highlighted that Bame medical professionals are likely to be treated differently and undersupported by their peers. It seems this is a discussion we as a profession are afraid to have.
Instead of action or widespread uproar, we’ve taken to simply applauding our colleagues posthumously. I understand that the government is launching an inquiry, but will this translate into any real-time outcomes such as measures to better assess, identify and distribute health care workers at higher risk to more suitable working environments? Instead, I fear we will continue to see the numbers of deaths rise disproportionately.
My Bame medical colleagues believe that this is a turning point for change; that once we are on the other side of this, no one will ever ask to be seen by a “white doctor only”. But does it really take this level of sacrifice to challenge behaviour? There have been multiple reminders questioning our equal place in society in recent years; the Windrush scandal, Brexit, our prime minister’s “colourful” language to name but a few. How can we expect to trust that our government will be any different in its attitude towards us now?
I do not share my colleagues’ optimism. The Covid-19 pandemic has merely sparked the beginnings of a conversation about being Bame in this country; a conversation that I see is already being muted, merely stating that an inquiry is to take place is insufficient. We need to know that prospective, robust data collection is happening. We need to know that this will be published and we need to know there is a commitment for transparency on this issue.
All that will change is that many individuals such as myself will undergo a stark realisation that the value of being “ethnic” in this society is to serve and be sacrificed.