Category: Social Issues

Change in Medicine

I have been involved in several circles dedicated to making systemic changes in medicine. A goal that started with optimism and hope has slowly been tainted by misaligned intentions and frustration.

Everyone has good intentions when establishing goals/priorities and starting initiatives, however, execution and implementation are very lacking. Many people have great desires and ideas, but few are willing to do the work to make the actual changes.

Many want to feel like they are doing something to relieve personal guilt, feel like they are part of something bigger, add a trendy goal to their resume…etc. However, as I witness many desires, I’m left wondering why the results aren’t matching such enthusiasm.

Why is change in medicine so difficult? Why is it that since medical school (or even since undergrad) students are not taught to put effort into the sociopolitical aspects of medicine? We are drilled to value certain accomplishments over others.

Even though the conversation is changing to say: “Yes we care about fighting equity in medicine, racism in medicine, the mental health crisis in medicine, lack of residencies for graduating physicians”; in reality, the efforts to change these things in medicine aren’t as valued as drilling out 5-10 papers about the “insert a very scientific title about a niche in medicine so you seem very smart”. We see tons of investment and recognition applied to efforts mainly dedicated to improving scientific research but not public health.

Recently, Congressman Murphy introduced a bill, the EDUCATE Act, in Congress to ban Diversity, Equity & Inclusion (DEI) in medicine. The EDUCATE Act reads as an effort to support “colorblindness” in medicine and states that DEI efforts are introducing harmful and exclusionary behavior in medicine. The Association of American Medical Colleges reports that 56% of active physicians are White (of which 65% are male), 16% Asian, 5% Hispanic, and 5% Black. So are we excluding by upholding these DEI efforts? When I look around my class, most people I see are white, and most physicians are white. When I attend programming dedicated to public health or advocacy, most attendees are women and mostly women of color. Some allies are white men (and whom we appreciate), however, there aren’t enough.

The anti-woke propaganda is spreading a false narrative that DEI efforts are meant to harm Caucasians, rather than to promote the inclusion of people of color in medicine. However, the actual truth is…POC are the ones who are mostly involved in efforts to improve the sociopolitical aspects of medicine. There is still a struggle to have allies who identify with the majority of people in medicine to be involved. Again going back to why efforts to change the “isms” in medicine are not regarded with the same value.

Are we improving medicine for a selected privileged few? Or do we want the great improvements in medicine to be accessible to the public? To be in a system that allows equitable access. In a system that appreciates well-rounded physicians and supports their physical and mental well-being.

Don’t get me wrong, I value science. The science is what started my interest in medicine. However, as I grew to understand that medicine intends to help patients, I started to expand my values to other sectors that impact patient care.

Science is imperative for medicine to move forward. For a time, it made sense for efforts to be hugely dedicated to such aspects of medicine. However, in these modern times, we are seeing how such dedication is affecting other aspects of medicine. We can see how it plays into physician burnout, physician suicide rates, low representation, and the value of people of color in medicine.

We can’t make the changes we apparently care about so much, without doing the systemic work of improving public health-related initiatives in medicine.

In my “Upstream Medicine” course at my medical school, we were given this analogy that stuck with me. Paraphrasing: there is a community whose main water source comes from a river; a huge rock blocks the stream up the hill so not much water reaches the community. Do we find a way to remove the rock or tell individual families in the community to figure out a way to bring in water?

I think right now in medicine we acknowledge we have a problem but rather than fixing the issue upstream, we are putting it onto certain individuals to make the change.

So how does addressing the issue upstream start? With changes from medical schools, residency programs, and hospital boards. With curriculums, requirements for residency, and definition of what an excellent clinician entails.

For example, instead of scheduling a wellness class for 3rd years on a Friday at 3pm, maybe we establish policies and behaviors to decrease the workload for students, residents, and physicians. Maybe we lobby and advocate for more physician hires and better pay across specialties so that doctors are not overworked and undervalued to the point of suicide.

There is this culture of: on the surface, you are to state the desire to make systemic improvements in medicine, while you are expected to not shake the table too much, and wait until you get into the room before demanding change. However also know that by the time you get to the room, you will have been broken down so much by the system that either you will be too burnt out to care or won’t have the same desire anymore because the system now finally benefits you individually.

Some individuals have a sincere desire to make changes in medicine; but, like me, when thinking about how things are and how slow change in medicine is, you are beginning to feel a bit frustrated and cynical.

Nonetheless, I’m holding on, very tightly, to some optimism and magical thinking I have regarding changing medicine. I am encouraged by mentors and peers who are in the safe spaces dedicated to making this change.

I want to encourage medical schools and hospitals to think about their mission and vision statements and reevaluate how they are upholding them, especially now as dangerous bills such as the EDUCATE Act are being introduced to our government.

I want to encourage medical students (especially our white male peers) to think back to those one or two essays submitted during the application process about vision and goals, diversity, health disparities, commitment to service, or cultural competency. Ask themselves what they have done/ could do to support those values they wrote about. 

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Articles to read: Murphy Introduces Bill to Ban DEI in Medicine

Tools to make change:

1. Visit the American Medical Student Association Activism Toolbox to see how to write a letter to your congressman
2. Find your congressperson and reach out to their office (it is within your right)
3. Make a goal for yourself to select a cause, learn as much as you can about it, and support an event or organization dedicated to such a cause. One small action is better than nothing at all.

Navigating my own anti-Blackness

So I recently read this paper (which I link below) that posed this question:

“Do these results indicate that Africans are more integrative into the white dominant culture than African Americans are?” 

My immediate answer was yes. My experiences and observances so far demonstrated a higher likeness towards Whiteness that begun to significantly change only once my interactions with African Americans grew. In my personal experience, my love (self-love) and advocacy for the Black diaspora, and all its features, would not have existed if I did not fully integrate with African Americans and see their issues as my own.

With my early stages of my development occurring in a White (European) setting, and also within the African community, there was an inclining towards viewing Whiteness as the goal or reference point. In the African community, (more than African Americans) there is a sense of upholding White people as better than Black people, which I believe stems from colonialism and the strive to reach the higher development seen in White western countries.

In addition, in some shape or form, I was being molded or molding myself into becoming a version of a Black African Immigrant that was acceptable to White society. I would study rigorously to show that the only African girl in my class could keep up with her Italian classmates.

There was a part of me that worked tremendously hard because I thought I (singlehandedly)could show that Africans can achieve the same goals set and accomplished by White Europeans.

I saw myself that way until I moved to the United States. My pride in being African was not associated with my Blackness. It was more cultural than racial. I knew, had experienced, and understood racism. But in my effort to fight racism in my own way by proving myself, in classrooms especially, I did not see that racism extended past me, past Africans. There wasn’t just our Black. But then again, I was not quite fully aware of the extent to how deeply anti-Blackness could run within others or ourselves.

When I moved here, I witnessed many (older) Africans try to distance themselves from African Americans: either by moving into a predominantly white neighborhood, telling their children to be wary of African Americans, condemning the lifestyle of African Americans, or failing to acknowledge or understand how systemic racism has impacted African American communities and how it extends to Africans as well.

At the same time, I witnessed African Americans belittle Africans: with derogatory terms, bully kids just for of being from Africa, or appropriate and diminish African lifestyles, without understanding it, or try to deny their African ancestry.

Many were the occurrences that led me to understand how anti-Blackness has been internalized within the African Diaspora to creating and amplifying cultural differences in complex ways.

As writer Nemata Blyden perfectly explains it “… I noticed the so-called divide between “Africans” and “African Americans,” while easily straddling both communities. This allowed me to understand the major differences between them, and to recognize that their historical experiences, while comparable in some respects, were radically different in others. From my vantage point, I also saw similarities that neither group would have recognized in each other.“

Moving here, I came to understand how systemic racism operates to oppress ALL Black people, learn the history and efforts of African Americans to dismantle racial discrimination, and their contributions to society and pop culture, and immense work to uplift pride and love of being Black. This is what allowed me to shift my reference point away from whiteness.

I now know I am deserving of everything because I said so and not because a white society deems me as worthy.

My goal is to not conform, belittle my Blackness in a way, to make white people comfortable. My goal is to exist fully, loudly Black however I may define it to be.

My point is I would not have reached this conclusion if I did not work to expand my interactions with African Americans, in a way that allowed me to share and understand their work to uplift Blackness.

I believe while a lot of work is happening within African communities to uplift ourselves, the fight against White supremacy (in the US particularly) is lacking, often seen as not “our” fight. In a way, it is because many Africans still uphold whiteness as what to strive for, rather than making our own goals.

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Articles to Read:

• “BLACK AFRICANS AND AFRICAN AMERICANS IN THE UNITED STATES OF AMERICA: DIFFERENCES AND SIMILARITIES” Case study by Shola Ajiboye
• “The Fiasco between Africans and African-Americans” by Joseph Abua

Videos to Watch:

• Colonialism in Africa: Yesterday, today and tomorrow | DW News Africa: explores how the Black Lives Matter movement extends to the work to eliminate persisting legacy of colonialism around the globe.
• History of Africa with Zaineb Badawi Series: detailed history of the African Diaspora from pre-slave trade to post colonization times.

No ordinary girl

Before you start reading allow me to state that gender is a social construct. Also, words like “masculine” and “feminine” or “girly” or “manly” are meant to be in quotations and this is my face everytime I use them.

Gender is not a two sided coin, with just two faces, it’s a spectrum that can be expressed however you choose.

I usually write a post many months in advance and just sit on it, revisit it some more before I share it. This also happened with this piece I wrote a little over a year ago, but felt unfinished with it. I agreed with what I was writing and feeling at the time yet still felt the need to reflect deeper. So I did, and think now, while I am still learning, I am ready to share. In cursive will be the piece I originally wrote last year, then I go to reflect on the realization I have been making since then.

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I know there is not a single way to define what it means to be a girl. Girls come in all shape and form with different characters. However, there is a specific type of women that are mostly represented in the media and in cultures as an “acceptable” form of a girl. Everything else is being “different”, not the “norm”. Especially growing up, I saw that a lot and was expected to act that way by my family. But I’ve never really been that way. I’ve never identified with the main female character (mostly because they never looked like me) and also because I never felt like what was considered a girly girl. My mom always pushed me to pursue certain behaviors that were attributed as feminine in our culture. I don’t quite know if it was because it was being forced on me or not but I never felt like that was me. I did want that to be me.

Yet,throughout my childhood and even now I struggle with feeling like I am not feminine enough. When I cut my hair, which was the most liberating thing I’ve ever done, but I would sometimes still feel insecure because I wanted to refrain from looking like a boy. In the first months after cutting my hair I would not wear some of my clothes (that I loved!) because they made look too boyish, I regularly got my nails done because they added a sense of femininity to me.

There’s nothing wrong with wanting to look feminine, but for a long time I felt like it was the only right way to be a girl. I like to think of femininity as a spectrum and I never felt like I was the most feminine. For so long during high school and college I felt like I had to be embody what we call “a bad bitch” in order to be seen as feminine. But it’s hard to be a bad bitch all the time. Sometimes I just want to be regular.

Additionally, I have struggled immensely to view and accept beauty and fashion as strengths. I have mainly embraced them because I was taught to be always look presentable, as a way to show that I belonged and get respect, especially due my socioeconomic and cultural background (combat that all Africans are poor and unkept stereotype, but that is a different conversation).

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Obviously, there are a lot of issues to reflect upon after reading that. But for the sake this post I am exploring my resistance against femininity. Because the truth is I did like indulging in feminine things so why the heck was I acting like I did not and trying to suppress those feelings since such a young age! Like why.

I realize now that it’s not that I was not into beauty and fashion or other girly things. I always enjoyed nice clothes, maintenance, love doing my hair and nails, I enjoy watching fashion, makeup, skincare videos on Youtube as much as my history or political videos. I just never had the confident to accept those things, indulge in those things because I perceived them as weak. I tried to show and preferred my masculine habits more, and used those to define myself because I thought that was what it meant to be strong. I did not want my feminine side to showcase me as weak. I was very misplaced in trying to reject certain things in my desire to continue to be strong willed and – I can’t even find a word to describe what I mean that does not have a masculine connotation behind it. 

But ironic (or maybe just tragic) enough I knew that I needed to utilize my feminine side mainly in order to combat that aggressiveness that is placed onto Black women. I was aware of how my assertiveness, intelligence, nerdy tendencies were viewed as somewhat too much for a girl with my ethnicity and race.

It’s like because of sexism I did not want to accept my great “feminine” qualities but because of racism I needed to use those qualities so I would not confirm that stereotype of the angry, too masculine, dark-skinned (because yes colorism!) Black woman. Because of these issues I needed to find an intersection where I had just the right amount of femininity to still be desirable yet strong, but too intimidating for people and even worse to scare a husband away.

Now that I am learning more about myself and social constructs I realize how I have been limiting myself, my skills, self esteem, confidence, growth (all of that!) to adhere to society’s level of comfort. I’ve always thought of myself as someone who likes to take risks, and in way does not care about others’ perception of beauty.

Unless it comes to fitting a stereotype.

My fear of fitting a stereotype (surrounding sex, gender, race and even sexual orientation) I realize, is because subconsciously I am subscribing to those prejudices and biases. Even though I know the blatant lack of truth stereotypes carry, I still carry those biases towards myself or others who are affected by similar stereotypes. 

In my last post I spoke about Rachel from FRIENDS and how for a while I didn’t like her also because she really indulges in pretty feminine habits. Yes, I have come to realize how wrong that was. But let’s unpack that real quick.

Monica and Phoebe still were very gender conforming in the show, however their most highlighted behaviors were not related to their femininity. Monica was a go getter, hardworking. Phoebe was quirky and tough. Most of these attributes can easily be seen as masculine. Rachel, I would say was the most gender conforming of them all. However, at first, the characteristic highlighted the most was not her fierceness but the fact that she was the pretty girl; along with her storyline being immediately tied to a man. While Phoebe’s lack of a definitive career was made to seem more because of her choice of a nontraditional lifestyle, the lack of definitive career of the more feminine character, Rachel, was because she was the spoiled girl “who still used Daddy’s credit card”, she was the pretty one who never had to work as hard.These wacky unsubstantial storylines are constantly given to more feminine characters in the media. 

I even see that with Livin Single (just to pick another great show from that era) with Regine. Regine (I also like to point out light skin, but I will come to that later) love for and sense of fashion, beauty was supreme in that show.

However her choice to pursue those things (which are socially labeled as “girly”), to also ultimately snatch a man (well ain’t that a coincidence!), was often ridiculed and portrayed to be looked down upon.

There is always this negative connotation surrounding a character’s choice to indulge in more feminine things.

Yet, Maxine, who by all means fits the more praised characteristics often associated with a man, still faced some sort of backlash, viewed as being too manly, too aggressive, and needed to be tamed. And yes, if you guessed right Maxine is dark-skinned. Having the same characteristics which are praised in a man or even highlighted as positive in a white woman (as we see with Monica, and Monica and Maxine are very similar), but vilified when it comes to a dark-skinned Black woman creates a harmful perception that continuously affects women like myself.

This sort of internal struggle that I have been experiencing my entire life, yes stems from my personal insecurities, but is deeply deeply rooted in sexist and racist stereotypes and harmful perceptions emphasized by our society and the media. 

So why was I rejecting femininity from such a young age? Because I did not want to seem weak. Even though I liked feminine things because that’s just who I am (I mean with all the magical girl anime I watched), I understand now that I was just trying to suppress them because the society viewed them as insubstantial. As a Black woman, additionally, because of racism and patriarchy, there is a lot of pressure and demand to be more feminine, sexual, strong and assertive (but not too aggressive), that makes growing up, navigating life just trying to be yourself much much more complicated.

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Video to watch: “The Girly Girl Trope, Explained” The Take on Youtube has a lot of videos explaining “tropes” in media and their social impact. Binge and learn.

Other favorite social commentary youtubers are: For Harriet and Tee Noir. The range of well researched content provided by these Black creators, diving into heavy or light hearted topics, challenging your perspectives…I’m here for it.

P.S. I do not own any copyright to the images included.