Scottish Racism in Medicine

Gina Yashere praising the NHS
‘I will never complain about the NHS again for as long as I live, trust me! We don’t know how good we’ve got it here…trust me!!’ This was a joke set-up by Nigerian comedian Gina Yashere[1] during her 2009 performance on the BBC’s Live at the Apollo comedy show. Though also a veteran of the Edinburgh Fringe Festival, her proclamation came after explaining her career had taken her to the USA where she’d ‘made the mistake’ of getting sick. After deciding to go to hospital for her ailment, they tried to charge her $15,000 for ONE NIGHT as an in-patient(!) Her further quip that it was bad service for a shared room with an old lady who farted all night was mere comic relief for the eye-watering amount the US healthcare system deemed fit to charge for equivalently free treatment on the UK’s National Health Service. Her enthusiastic praise for the NHS elicited whoops and applause from the Apollo audience, much like the well-deserved adulation currently sounded out across the country since the March 2020 ‘Clap for our Carers’ campaign. The celebration of hospital staff as they risk their own lives to save others battling the coronavirus pandemic sweeping the globe is the very least we can do as we more safely self-isolate in our homes. But Gina soon noticed a missing element to the faces of surgeons, doctors, nurses, paramedics, and key workers on the British newspaper’s celebratory frontpages…they were all white. ‘If you’ve been to a hospital in the last 50 years [certainly since Windrush], you know that’s not what the NHS looks like,’ she implored in a video condemning the omission of the disproportionately high ratio of BAME staff in the UK health service.[2] That said, the contribution and heroism of people of colour being erased from public record is only one aspect of racism that affects BAME communities in relation to the NHS all across the country even before the Covid-19 pandemic, including in Scotland.

Racism in Patient Treatment

Being injured or ill is a time when we feel the most vulnerable as people, hence we place a lot of trust in healthcare workers and hope they engage us with compassion. However, this was not the case with a pregnant British woman when she received a letter from a Scottish hospital that questioned her UK residency. Apparently, the threatening tone in the correspondence regarding her right to free NHS treatment was triggered by her ‘foreign-sounding name’.[3] On other occasions, the racism BAME patients receive is not quite as overt. Throughout the current pandemic, there have been many stories right across the country of Black people not receiving proper care when they draw attention to their health issues[4]such as not being treated by paramedics who are called to their homes, or being turned away after multiple visits to hospitals. One Glasgow-based Guyanese nurse recounted an occasion when a BAME in-patient said they were in pain and the white nurse on their ward thought they were ‘putting it on’, even rolling their eyes when the patient requested more pain killers. This in part is explained by a historical innate bias within western doctors with regards to Black people. As far back as the 1700s, medical journals erroneously claimed Black people have a higher pain tolerance than whites. Now in 2020, medical surveys still show white trainees believe their future Black patients are less sensitive to pain than their future white ones. As such, the ‘foreign-sounding’ British pregnant lady at that Scottish hospital might have further cause for concern regarding her treatment when she is ready to give birth considering in recent years Black mothers are 5 times more likely to die in childbirth than white mothers.[5] More specifically, the finding of the Mothers and Babies: Reducing Risk through Audits and Confidential Enquires (MBRRACE) report stated the death rate for Black, Asian and white mothers were 40, 15 and 8 per 100,000 pregnancies respectively, a truly worrying disparity. And even if the mother survives, the chances of her child’s survival is also disproportionately skewered as stillbirths and newborn deaths are twice as high amongst Black babies.[6]  

Black mothers at higher risk of death in childbirth, stillbirths or newborn deaths 

Just like in non-pandemic times, a disproportionately higher number of coronavirus victims amongst patients have been BAME. Of all the various symptoms of Covid 19, an extra one ethnic minorities face in Scotland is the interpretation that ALL people of colour have the disease, apparently resulting in by many of the white Scottish public social DOUBLE distancing upon sight(!) Coming back to the incongruent stats, in addition to the aforementioned overt and covert racial biases including being turned away for treatment due to misperception of pain/discomfort levels, more underlining systemic racism may be a contributing factor. So far, the highest coronavirus death rate in Scotland has been in Greater Glasgow and Clyde, which is renowned for its entrenched poverty. The area is also one of the most ethnically diverse in the region, meaning those from less affluent households could inhabit professions that give them more exposure to the virus.[7] This includes bus and taxi drivers, couriers, supermarket workers, home carers or hospital cleaners. Another possible factor is living in over-crowded households meaning more exposure to others and thus a higher chance of contracting the virus. In any case, low-income does not factor into why BAME surgeons, doctors and nurses are also succumbing to the Covid-19 at a higher rate. Indeed, they have their own encounters of racism too.

Racism in Medical Staff Treatment

Medical practitioner Dr Aruna Adébáyọ̀ Abdul
One such doctor was my father, Dr Aruna Adébáyọ̀ Abdul who worked as a medical practitioner based at Yorkhill Hospital in Glasgow in the 1970s/80s. So often, people would look past his white coat to his dark brown Nigerian skin and disrespect him contrary to what his profession should warrant. The was echoed by other doctors who spoke to the Herald Scotland, including Edinburgh-based consultant cardiothoracic surgeon Dr Vipin Zamvar. A 30-year NHS veteran and member of British Association of Physicians of Indian Origin (BAPIO), he shared that his associates had experienced differing forms of racism in their careers.[8] This is corroborated by Dr Usman Rehman who once had a patient ask why he was so ‘tanned’ if he was Scottish.[9] He quipped he was from southern Scotland, which received much more sunshine than the Lancashire area where he practices. However, there are other instances that are not so easily covered with good humour as shared by Indian Dr Punam Krishan who also lectures at Glasgow University. On occasion, she has been referred to as the ‘coloured doctor[10], both ignorant in terminology as well as decency considering she has a name. But in Jan 2019, the ignorance went beyond proper address when a white patient visited her GP surgery and saw Dr Krishan walk out to reception. The patient then approached the receptionist and asked for an appointment ‘but not with an Asian doctor[11], intent on joining the ranks of many before her who have refused to be treated by BAME physicians.

Paramedic Araf Saddiq
Such behaviour is bad enough when it comes from the patients, but it takes on a deeper potency when it comes from fellow medical staff as Dr Krishan recalled from early in her career. A nurse called one of her junior doctor colleagues ‘a ninja’ referring to her appearance.[12] The ill-mannered ‘joke’ caused such distress that the doctor in question was in tears over the incident, though she did not feel she could speak up about it. Other medical staff to find themselves in the same quandary include ambulance personnel like Glasgow-based Araf Saddiq who shared, there were always comments made and undertones in mess rooms that I wasn'comfortable with.[13] Beyond such comments, he was even attacked by one of the patients he’d aided and transferred to hospital. Quite suddenly, his patient turned around and shouted racist slurs whilst violently assaulting the paramedic who suffered injuries to his shoulder and knee. Again, the incident caused much distress and Araf needed counselling to process it.

GP & lecturer Dr Punan Krishan
Of these racist incidents towards medical staff, Dr Krishan reflects that ‘disease does not pick a gender and disease does not picka colour. When you strip it back we are all human[14],’ a fact that bigots seem painfully indifferent to as they dehumanise the people trying to help them. Though rather than refusing to treat such individuals, all too often paramedics, nurses, doctors and surgeons alike still choose to carry out their duty of care and see that the patient is ‘safe and well’ as was their intention when signing the Hippocratic Oath. ‘When people are on their last breath, they’re all the same. Two people suffering from cancer are still human beings going through the same processes. You can’t judge them because of the colour of their skin or the religion they follow.’ However, that sentiment is not always what they get back in return from the patients or indeed their colleagues. For Dr Krishan, such events sparked a wider reflection, if [BAME doctors] are exposed to bullying, harassment and racism, it impacts on the quality of care we provide, our mental well being and ultimately leads to absenteeism and staff turnover.’[15] Thus, there should be more support from the establishment, yet all too often BAME medical staff are shown just the opposite.

Racism from the Scottish medical establishment manifests itself in a variety of ways. The first is career hindrance[16] which the ‘Fair for All’ review conducted by Glasgow Public Health consultant Dr Rafik Gardee highlighted. Its findings included BAME doctors working as locums - temporary stand-ins - for many years without being employed as full-time consultants with the right to undertake private medical work. Then, once they finally reach this status, Black doctors are promoted less than their white colleagues.[17]

Royal College of Nursing's (RCN)
Acting Chief Executive
Professor Dame Donna Kinnair
Amongst other considerable disparities between health boards and trusts in policy as well as practice was the issue of income inequality.[18]  The 2018 NHS Digital survey show that Black doctors are paid approx. £10,000 less than white doctors, prompting condemnation from the British Medical Association (BMA) trade union chair Dr Chaand Nagpaul. ‘It cannot be right that in 21st-century Britain there are such wide gaps in pay between white and BME doctors when, irrespective of their background, they hold positions to deliver the same care to patients.’ Similarly, the survey showed Black nurses are paid approx. £3,000 less to the indignation of Royal College of Nursing's (RCN) Acting Chief Executive Professor Dame Donna Kinnair. For her, the massive pay gaps stem from the shocking lack of diversity in senior positions[19] considering, whilst 25% of the NHS workforce across the country are BAME staff (as Gina Yashere quite rightly drew attention to), only 7% of senior managers are BAME. ‘This lack of diversity means the NHS leadership fails to reflect the population it serves.’

BMA Scotland Chair, Dr Lewis Morrison
The unrepresentative leadership may also explain the disparity of more complaints being made against BAME medical staff being investigated and then upheld by health regulators[20] Between 2010 and 2016, the General Medical Council (GMC) investigated grievances against 10.2% of doctors of colour versus 8.8% of white doctors. Dr Krishan lamented this is currently a huge fear among ethnic minority doctors across the UK that should something go wrong with their patients, they will face discrimination and be more likely to be handed harsher punishments because of their ‘foreign-sounding names’ on paper, or skin colour on sight. BMA Scotland Chair, Dr Lewis Morrison is well aware of these issues, acknowledging Scottish BAME doctors are still ‘morelikely to be bullied or harassed, experience differential attainment in their careers and are more likely to be referred to the GMC,’ and whether it is fuelled by subconscious or conscious bias, it is completely unacceptable.[21]

Again, just like in non-pandemic times, could all these discrimination indicators feed into why a disproportionately higher number of coronavirus fatalities amongst medical staff have been BAME? After all, right across the African continent, government responses have been very effective in curtailing the effects of Covid-19 on their populations. By contrast, stats from the April 2020 Health Service Journal (HSJ) analysis in England where ethnic minorities make up 14% of the population show that, whilst 25% of NHS staff are BAME, 44% of Covid deaths of medical staff are BAME.[22] As mentioned before, systemic factors like poverty would not affect high-income medical staff. Some have therefore suggested biological factors like our more melanated skin meaning less vitamin D absorption from sunlight which affects immune system strength could contribute to the higher death rates amongst people of colour.

Nigerian doctor Alfa Sa'adu who came out of
retirement to help fight Covid-19
passed away after contracting the disease
However, one disturbing explanation could again be linked to medical education where a lack of diversity of patients means healthcare trainees do not recognise nuanced differences in how disorders can present in non-white ethnicities. Similarly, as health research subjects are not diverse, any research outcomes are not representative of the wider society, thus unable to provide more universally effective treatments. Beyond this, more immediate and sinister possibilities for the racial disparity in Covid deaths were recently brought to light by the Head of Equality, Diversity & Human Rights at Birmingham Community Healthcare NHS Trust, Carol Cooper. She shared that BAME staff are being reassigned from the wards they normally work into Covid wards and thus exposed to Covid patients more than their white counterparts.[23] Their feeling is that ‘the same bias that existed before is now influencing their reassignments and they are terrified,’ with similar concerns reportedly felt by BAME staff at Edinburgh Royal Infirmary. This is understandable considering the UK’s first 10 Covid-19 fatalities amongst doctors were from BAME backgrounds including Sudan, Nigeria, Sri Lanka, Syria, Bangladesh, Pakistan, Iraq, Democratic Republic of Congo amongst many others.[24] The sentiment echoes Dr Krishan’s that, even though they have dedicated their lives to help others, BAME staff are seen as less valuable and even expendable(?) With their glaring omission from the ‘Clap for our Carers’ newspaper frontpages, it is perhaps not too far-fetched an assumption…

National Records of Scotland
Does such a worrying disparity also exist in Scotland where BAME people make up 4% of the population? Well, as of yet no such analysis of Scottish Covid-19 deaths by ethnicity exists[25] as the National Records of Scotland (NRS) do not include this information in their weekly ‘Deaths Involving Coronavirus’ reports. The reason given is that ‘the registered death data is not suitable for calculating reliable mortality rates for most ethnicities’[26] as their spokeswoman cryptically stated. But bearing in mind BMA Scotland Chair, Dr Lewis Morrison’s stance on racial harassment and discrimination towards BAME doctors, it is not difficult to imagine a review of coronavirus fatalities in the region might skew similar to the rest of the UK as a whole with the Office for National Statistics (ONS) stating this month that Black people are 4 times more likely to die from coronavirus than whites.[27]

Racism in Mental Health
When racism and racial discrimination have such negative impacts on the daily lives of BAME people including the outcomes of their physical health, it is no wonder that it would then negatively impact their mental health. The Royal College of Psychiatrists were particularly concerned about reports showing the disproportionate mental health impact on people from BAME communities,‘notably those of Black African and Caribbean heritage’.[28] This is understandable as a 2004 study policing Strathclyde racist incidents that year found that whilst only 40% of white Scots had suffered property damage, threats, offensive remarks or physical assault in public spaces, victims of such crimes increased to over 60% of visual minorities and even higher to 80%of BAME women specifically in the same time period.[29] Ethnic minorities being a higher target of crime in Scotland has not changed through the years considering the region currently has a ‘higher rate of race-related murders per person than the rest of the UK.’[30] Considering the greater levels of antagonism and violence, it is no wonder that BAME victims are also reported more likely than whites to be profoundly effected in the aftermath of such attacks with feelings of ‘anger, stress, depression and sleepless nights,’ mirroring the trauma that Dr Krishan’s colleague and paramedic Araf Saddiq felt in the wake of their racial attacks. More worryingly, the studies show that racism-induced mental stress can have a debilitating physical effect at a cellular levelcausing decreased antiviral immune responses against such pathogens like Covid-19, and increased inflammation which can then lead to cardiovascular disease, Type 2 diabetes and cancer, bringing further stresses with it.

Racism induced mental distress
It is understandable that, to adequately manage this heightened anguish, professional help would be needed. However, a 2014 Adult Psychiatric Morbidity Survey (APMS)[31] revealed that, even though Black British adults had the greatest severity of mental health symptoms, they were the ‘least likely to receive treatment for mental illness’. This is partly due to ‘circles of fear’ hindering Black engagement with eurocentric mental health services often regarded as ‘inhumane, unhelpful and inappropriate’. This in itself can further heighten mental distress threefold[32] from (1) racism and racial discrimination (2) white majority stigmatisation re mental illness (3) BAME minority stigmatisation re mental illness.

Regardless, some do reach the point of seeking mental health support, though these voluntary referrals[33] can be fraught with issues. After consulting their GP, Black patients’ disorders are more dismissed/unrecognised or even mis-diagnosed. When properly recognised, Black patients were less likely to receive medication. Even when prescribed, the dosage of anti-depressants and minor tranquillisers suggested is often insufficiently lower or damagingly higher than their white counterparts. Furthermore, the range of treatments offered such as talking therapies is more limited and Black patients are often not referred early enough for specialist mental support services. All of these led to many feeling, ‘misunderstood within the mental health system because they are feared, stereotyped or ignored’.

Disproportionate number of Black men sectioned
Black people’s distrust/dissatisfaction of such services mean most of the community’s mental health engagement is through involuntary referrals[34] based on detention orders requiring enforced hospital stays. A Commission for Racial Equality (CRE) analysis found that, of all the BAME people sectioned under the Mental Health (Scotland) Act 1984, 37% were Black Africans, even though they only made up just over 5% of the Scottish BAME population (the majority being Asians and other Europeans). This disproportionate overrepresentation again suggest systemic racism is at play. Once detained, they could yet again see racial disparities in treatment[35] with a 2013 study finding Black patients were 29% more likely to be forcibly restrained, 50% more likely to be placed in seclusion, and also more likely to be diagnosed as psychotic than white detainees, adding to the distress of an already stressful situation.

So, coming back to Gina Yashere’s 2009 proclamation of ‘never complaining about the NHS again for as long as she lives’, whilst that might have been genuine at the time, perhaps she would revise that assertion upon understanding the extent of racism directed at NHS staff of colour as well as potentially the Nigerian comedian herself as a patient of colour.
Course of Action
So now we know of the racism against BAME people within Scottish medicine, what can be done about it? Let’s break it down step by step.

Kawasaki disease skin comparison
Regarding BAME patients, the Scottish government have issued NHS chief executives with guidance for the treatment standards that should override unequal health outcomes[36] such as the disparity of Black mothers dying in childbirth, as well as stillbirths/newborn deaths. There should also be healthcare/wellness information for the public available in a wide range of languages, audio tape or braille, a move welcomed by the British International Doctors Association (BIDA), formerly the Overseas Doctors Association. Along the same vein, the Coalition for Racial Equality and Rights (CRER)’s Race Equality Framework for Scotland Community Ambassadors Programme[37] stated that ‘culturally sensitive health services were needed to ensure practitioners could identify different needs, experiences, and viewpoints and provide an appropriate service for all,’ thus health services awareness raising seminars could take place within community groups. In this way, BAME community members who were previously disinclined to visit their GP (perhaps for example by feeling unable to request being treated by a doctor or nurse of the same gender) would be more encouraged to access healthcare. Furthermore, health practitioners should be more aware of general or rare diseases ‘more prevalent in specific communities[38], like sickle cell anaemia in West African origin groups, or diabetes and cardiovascular condition South Asian origin groups. Moreover, there should be training on how more universal disorders present in different ethnicities. This is a knowledge gap that Zimbabwean medical student Malone Mukwende bridge with his handbook ‘Mind the Gap’ demonstrating ‘how clinical signs appear on darker skin’. The importance of this has far reaching benefits, ‘changing the landscape of medical education all over the world for years to come, as well as improve medical treatment for black and brown people’One immediate benefit would be a more rapid diagnosis of the coronavirus-related ailment Kawasaki disease.

Scottish Ambulance Service Equality Outcomes Consultation
to improve engagement with all Scottish communities 
As well as community programmes promoting ‘preventive medicine’ like healthy lifestyles and wellbeing activities, the efficiency of first responders to emergency situations is also being reviewed by the Scottish Ambulance Service to ‘deliver a service that reflects the mixed communities and population of Scotland’coordinated by an Equality & Diversity Steering Group (EDSG).[39] Such sensitivity training would certainly help with any callouts related to the current Covid-19 pandemic where elsewhere in the UK, BAME patients have been received inadequate to negligible attention from paramedics who labelling them as ‘not a priority.[40]

Regarding BAME medical staff, one of the most crucial push backs against racism is the support of their fellow staffers as was the case with Dr Punan Krishan. After the racist patient objected to an Asian doctor, her white receptionist asserted the doctor of Indian origin was Scottish.[41] When the racist patient responded, ‘She doesn’t look Scottish’, the receptionist replied, ‘What do Scottish people look like?’ The challenge from a fellow white person clearly unsettled the patient, who then silently took the appointment card and waited to see the doctor. Dr Krishan spoke of her pride after hearing about the interaction, ‘I feel I belong here – I was born and brought up in Glasgow – but I’ve never really had a white person who is “native to Scotland” stand up and make me feel that I was an equal.’ 
Paramedics are highly affected by abusive individuals
However, she also felt more could be done to equip doctors with training on how to deal with specifically racist patients[42] rather than just generally angry or abusive ones, meaning more would speak out about it instead of choosing to just get on with their jobs. Beyond this, there is now new legislation as of April 2020 stating that NHS staff can refuse treatment to non-critical patients spewing racist, sexist or homophobic remarks in addition to harassment,bullying or discrimination as well as verbal and violent attacks.[43] Police have also been given ‘more powers to investigate and prosecute cases where NHS staff are the victim of a crime’ like in the case with paramedic Araf Saddiq.

Something must also be done to tackle racism from fellow staff and health trusts, particular as the NHS Workforce Race Equality Standard(WRES) report noted discrimination towards BAME staff rose to 15% in 2018 as opposed to just 6.6% of white staff in the same time period.[44] RCN Chief Executive Professor Donna Kinnair said, ‘It is up to employers and policymakers, working with trade unions and other organisations, to put an end to this once and for all.’ She added that the RCN were willing to collaborate with NHS trusts to make this a reality and are holding an Inclusion Summit in summer 2020 to confront all forms of systemic discrimination and inequality in all facets of UK healthcare. This will surely include standardised career progression markers so any locum doctor would transition to a consultant after a set timeframe of quality medical service delivery regardless of race. It should also include standardised salary and progressive incrementation at certain career
Cardiothoracic Surgeon Dr Vipin Zamvar
milestones through pay transparency. Of particular importance would be achieving proportional representation in senior management positions as Professor Kinnair insists is essential to neutralising racism. Similar representation would undoubtedly help in regulatory bodies like the GMC too. ‘It is important for NHS Scotland to be aware that there might be subconscious racism in its institutions, and to take proactive steps to monitor and record any behaviours that can be perceived as such,[45] 
said Dr Vipin Zamvar. He suggested data collection on complaints, outcomes of complaints, disciplinary action; and further research should BAME staffers be disproportionately represented to explain the reasons why. BMA Scotland Chair Dr Lewis Morrison is in agreement stating, ‘A starting point to tackling this problem in Scotland must be to bring it into the open and that requires NHS Scotland to start gathering and publishing the same level of data on racial equality that NHS England does.’

BAME NHS staffers featured in ‘You Clap For Me Now’ 
Perhaps this more visual inclusion and self-reflection at the top levels would trigger more societal respect for BAME healthcare staff so the British newspapers would automatically think to include them in their ‘Clap for our Carers’ frontpages praising NHS workers helping us fight against the coronavirus, and not trigger the anti-racist ‘You Clap For Me Now’ movement in the wake of their jarring omission.[46]  These staffers have merit both during AND after the COVID-19 pandemic, so once it is under control the UK hopefully doesn’t go back to ‘racism as usual’.[47]

Regarding BAME mental healththere of course needs to be societal change to reduce if not eliminate racial harassment and violence, hence less impact on BAME mental health. In the meantime though, to minimise the racial bias during voluntary referrals, the Royal College of Psychiatrists have put forward various recommendations.[48] At the professional level, the Department of Health and Social Care (DHSC) should establish a ‘Health and Social Care Observatory to monitor, track implementation and report on the impact of policy and practice on the mental health of patients, including BAME groups.’ At a training level, NHS Scotland should collaborate with ‘Medical Royal Colleges and other organisations to promote effective training for NHS organisations to monitor and address factors that put BAME groups at a disadvantage’. The Royal College of Psychiatrists in particular have appointed an Associate Dean for Equality, Diversity and Inclusion to liaise with educational developments to assist psychiatrists throughout every juncture of their careers. To help facilitate this up north, the Mental Health (Care and Treatment) (Scotland) 2003 Act should have 'equality', 'diversity' and 'non-discrimination' considerations implanted throughout its mandate.

The National Resource Centre for Ethnic Minority Health (NRCEMH) in Scotland has pursued research at the behest of the National Programme for Improving Mental Health and Well Being (NPIMHW) on how to best implement a transcultural mental health network that would lead to initiatives similar to Black Thrive, the Afiya Trust[49] or Rochdale & District Mind BAME Services.[50] Particularly key is ensuring the participation of individual BAME communities and their diverse needs[51] in further development of future policies. This could include the
Culturally sensitive and racism-impact aware service provision
provision of suitable translation and interpretation services (with specific mental health terminology training for interpreters); understanding both the unique aspects of cultural identity as well as impact of racism on mental health; developing appropriate assessment and diagnostic tools; being respectful and sensitive to spiritual requirements; delivering equal access to culturally appropriate services including advocacy, counselling, psychotherapy and befriending; facilitating access to appropriate housing, training and employment, welfare benefits, child-care for support during the recovery process. In addition to improving the competence of mainstream services and developing 'specialist' services, there is also the development of the voluntary and independent sector, including self-help groups. With such support in place, it would potentially also decrease the number of involuntary referrals and the resulting inequalities that BAME patients undergo once sectioned.

Empowering Scottish BAME Communities

Whilst waiting for all these measures to be implemented, BAME patients’ racist experiences with healthcare currently means that, despite initiatives like the community ambassador programmes, many are still less likely to see a doctor or seek other medical support. This means more time for illness to fester and thus lower health outcomes. Paramedic Araf Saddiq is all to aware of this, understanding that ethnic minority communities are ‘fearful of contacting and using the health service’ as there is plenty of ‘mistrust - barriers in people's minds’. How to lift the barriers to healthcare engagement? One solution is for more BAME people to be trained to deliver first aid in emergency situations. Another is for live-saving
MANSAG mentoring and coaching event
devices to be at the heart of communities so they can use them independently. To this end, Araf has been campaigning to raise money for defibrillators to be installed in mosques, temples and churches.[52] Also, what of BAME medical trainees who might be put off by all the racism they would currently face in the profession either from patients or more disconcertingly from their colleagues and employers? Luckily, there are supportive 
initiatives like the NHS Greater Glasgow & Clyde (NHSGGC) BAME Staff forum to help challenge ‘stereotyping, discrimination and organisational culture, as well as the impact of negative media reporting and the anti-immigration climate’. The group have so far taken steps towards tackling racism by requesting racism awareness training across the board. Other supportive enterprises include thMedical Association of Nigerians Across Great Britain (MANSAG)[53] who provide peer-networking as well as mentoring/coaching programmes and advice on career pathways that will encourage and steer them in the right direction.

The Colour of Madness / Racism and Cultural  Diversity
Overcoming similar hesitation to engage with mental health services could be an elongated process, yet some BAME individuals have chosen to creatively repackage their mental struggles stemming from racial inequality and other stresses, drawing on them for
inspiration for poems, essays, memoirs and more in the 2018 anthology ‘The Colour of Madness[54] 
compiled and edited by Dr Samara Linton and Rianna Walcott through Stirling Publishing. Further illuminating books include M.J. Maher’s Racism and Cultural Diversity: Cultivating Racial Harmony through Counselling, Group Analysis, and Psychotherapy.  
The book is said to possibly be the first to use renowned psychologist John Bowlby's Attachment Theory as ‘a framework for understanding racism’.

Baba Yangu Foundation / Mind Café ‘Art for the Soul’
the literary medium, the Scottish BAME community can also find support at ‘Advocacy Matters’ which provided independent mental health advocacy in the Greater Glasgow area. Similarly, Saheliya provides specialist mental health and well-being support for BAME women and girls (12+) in the Glasgow and Edinburgh area. 
Additionally, there’s 'Black Thrive', 'Black Minds Matter' as well as the ‘Baba Yangu Foundation’, a multifaceted Ugandan and Kenyan faith-based charity providing counselling and therapy, and working to ‘eradicate the stigma and isolation associated with mental illness' in Scotland's Black community. There’s also online support during the lockdown through the Mind Café[55]a Nigerian-run faith-based mental health support initiative which uses ‘art for the soul’ to help heal the mind. Currently offering free online sessions for ‘Integrated Pathways to Emotional Wellbeing[56] and organised by a professional psychiatrist and award-winning artist, they have a deep understanding that patients should have a therapist with shared experience (in this case racism), otherwise ‘therapy can be a near useless endeavour’. Although based in London, their ‘Black Mental Health Matters[57] conference is a non-profit mobile initiative that travels the country and even to Scotland at the behest and funding of local communities, delivering workshops designed to help participants neutralise stress-causing external toxicity and ‘guard the mind’.

Yes, Scotland has a long way to go before resolving its issues with racism in medicine, and only with a concerted effort will progress be made.

~ by Abiọ́dún Ọlátòkunbọ̀ Abdul

[1] Gina Yashere, Live at the Apollo, 3:25 in (1 Mar 2009)
[2] Gina Yashere, talks about Covid19 & the NHS (28 March 2020)

   You Clap for Me Now: the coronavirus poem on racism and immigration in Britain (15 April 2020)

[3] Comment: Stop downplaying the experience of racism in Scotland (8th March 2018)
[4] This global pandemic is exposing the medical bias against black women in healthcare (9th April 2020)

[6]  Black babies are more likely to be stillborn. That is institutional racism (3rd July 2019)

[7]  Coronavirus in Scotland: How many deaths are linked to obesity and poverty? (23rd April 2020)

[8]   Is our NHS racist? Medical chief calls for monitoring of racism against BME doctors in Scotland (17 Feb 2019)
[9]   Receptionist praised by Scottish GP for her response to 'racist' patient (17 Jan 2019)
[10] GP claims black and ethnic minority doctors are more likely to have complaints against them investigated and upheld (13 May 2018)

[11] My patient made racist remarks about me. I decided to do something about it (22 Jan 19)

[12] My patient made racist remarks about me. I decided to do something about it (22 Jan 19)

[13] 'I was Scotland's first Asian paramedic' (5 October 2018)
[14] Receptionist praised by Scottish GP for her response to 'racist' patient (17 Jan 2019)

[15] My patient made racist remarks about me. I decided to do something about it (22 Jan 19)

[16] Scots tackle racism in health service (5th June 2002)

[17] GP claims black and ethnic minority doctors are more likely to have complaints against them investigated and upheld (13 May 2018)

[18] Britain's NHS pays Nigerian and black doctors about £10,000 less than their white colleagues (28 Sept 2018)

[19] Rise in reported racial discrimination in the NHS a disgrace, says RCN (16 Jan 2019)

[20] GP claims black and ethnic minority doctors are more likely to have complaints against them investigated and upheld (13 May 2018)
[21] Is our NHS racist? Medical chief calls for monitoring of racism against BME doctors in Scotland (17 Feb 2019)

[23] Exclusive: BME nurses ‘feel targeted’ to work on Covid-19 wards (17th April 2020)

[24] These are the health workers who have died from coronavirus (4th May 2020)

    Doctor who pleaded for more hospital PPE dies of coronavirus (9th April 2020)

[26] Scottish Government urged to publish ethnicity data of Covid-19 victims (26 April 2020)

[28] Racism and Mental Health, Royal College of Psychiatrists

[30] Book exposes ‘fantasy’ that Scotland is less racist than rest of UK (8th May 2018)

[35] Health and Mental Health Statistics

[36] Scots tackle racism in health service (5th June 2002)

[37] Race Equality Framework for Scotland Community Ambassadors Programme, CRER (April 2016)
[40] Mum, 36, dies of suspected coronavirus after being told she was not a priority (25th March 2020)

    London woman dies of suspected Covid-19 after being told she was 'not priority' (25th March 2020)

[41] Receptionist praised by Scottish GP for her response to 'racist' patient (17th Jan 2019)
[42] My patient made racist remarks about me. I decided to do something about it (22nd Jan 19)

[44] Rise in reported racial discrimination in the NHS a disgrace, says RCN (16th Jan 2019)

[45] Is our NHS racist? Medical chief calls for monitoring of racism against BME doctors in Scotland (17th Feb 2019)

[46] You Clap for Me Now: video hails key workers with antiracist poem (15th April 2020)

[47] You clap for me now - but give it a few months and it’ll be racism as usual (15th April 2020)

[52] I was Scotland's first Asian paramedic (5 October 2018)

[53] Medical Association of Nigerians Across Great Britain (MANSAG)

[54] The Colour of Madness, Stirling Publishing

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