The incident happened at the Théâtre des Grands Danseurs du Roi, commonly known as the Nicolete Theatre in Paris, in September 1784. Alexandre Dumas recounts it in his Mémoires. [1] General Dumas, the debonair son of Count Davy de la Pailleterie, was with a young society lady when he was subjected to racial slurs and insults. The dark skinned, mixed race Dumas was first mistaken as a servant, then asked to kneel and beg for pardon before being arrested by the police. General Dumas was born in the French colony of Saint-Domingue (modern day Haiti) to a white French aristocratic general and a slave-born mother Marie-Cessette Dumas. One of the most prolific and celebrated novelists in history, Alexandre Dumas’s life was also scarred by the systemic and pervasive racism in an all white society that only accepted Black people as slaves. His father, General Dumas, embraced the Revolution of 1789 with its call for liberty and equality. In The Count of Monte Cristo, Alexandre Dumas says: ”All human wisdom is contained in these two words: wait and Hope.” [2]

Over two centuries later, the world is done with waiting, but there is now renewed hope for racial justice and true equality. Hope is not unbridled optimism, which has more in common with its cousin Hubris, it is cautious and shy, as Emily Dickinson wrote: ”Hope is the thing with feathers/ That perches in the soul/ And sings the tune without the words/ And never stops—at all” [3] 

The recent ugly events in the US and the devastating effects of the pandemic on people from ethnic minorities are just the latest manifestations of structural racism and discrimination in our societies. [4] We must confront this truth and seek to undo its damages. A decade of austerity has exacerbated all, health and economic inequalities, but divisive rhetoric on immigration, the hostile environment, and the vilification of minority groups has had a disproportionately damaging impact on ethnic minority communities, including so many of our NHS colleagues. As the recent Public Health England report shows, it is not just socioeconomic factors responsible for a disproportionately high mortality from coronavirus among ethnic and racial minorities in England, but “historic racism” plays a significant part as well and even subtle forms of race-based practices could be harmful in perpetuating racial health inequities. [4,5] When confronted with this reality, the instinctive response of the government is to deny, detract, and bury the evidence. [6] 

Ethnic minority communities are well represented in the staff of the NHS but also in other essential services: bin men, delivery men, shelf stackers, wardens and transport staff. They have had to struggle disproportionately to hold these services together—while, at the same time, our political leaders have continued their campaign of privatisation, fragmentation, and destabilisation throughout the hypocrisy of the Downing Street clapping. The huge sums spent and wasted on testing and the tracing and tracking app could all have been funnelled through the NHS, using, strengthening and building on existing local expertise and institutional memory—instead the money had gone to private companies, which have no real expertise or understanding of either public health or clinical care. [7,8]

Ethnic minority staff are reluctant and afraid to speak out about issues that put them at higher risk of covid-19 such as lack of personal protective equipment (PPE). [4] The lack of PPE serves as an exemplar, and almost a metaphor, for the diminished state of the NHS after years of austerity. Describing ethnic minority staff as heroes is an empty platitude while allowing and accepting the soul-destroying conditions under which they have to work with the constant weathering effects of microaggression and daily insults.  

The scenes we are witnessing in our homes, towns, neighbourhoods, and TV screens, with a resurgent Black Lives Matter, have reawakened our sense of who we are, who we have been, and what we value. It has nudged the societies, at least in the English-speaking countries, to pause for reflection. We are beginning to see with greater clarity the brutish knee of injustice and systemic discrimination on the necks of many lives, causing devastation and premature death. 

Affection and appreciation of the NHS, staffed by the Windrush generation and other minorities, is perhaps the highest it has been. It embodies social solidarity and acts on a basic moral imperative: our commitment and pledge to look after each other in times of crises. Yet structural racism has infected the NHS too, failing people from ethnic minorites as patients, doctors, nurses and healthcare assistants. It is not that they are not reached enough, they are hardly reached at all with patchy, sometimes stigmatising, and rarely culturally sensitive healthcare and health policy. [9] Similarly, in the handling of complaints, the disciplinary processes, in awarding of jobs and in career progression, people from ethnic minorites have had a profoundly unjust treatment. [10]

The NHS must have the courage to seize this hopeful moment to step up the fight for justice. The time for talking about righting this wrong is over, it is time to do something and do it now. It starts with implementation of the recommendations of government’s own reports: the Lammy review into racial bias in our criminal justice system, tackling workplace racism, and redressing the suffering of the Windrush generation. [11,12,13]  

This moral outrage will not go away. As Dumas writes in The Count of Monte Cristo 

“Moral wounds have this peculiarity – they may be hidden, but they never close; always painful, always ready to bleed when touched, they remain fresh and open in the heart.” [2]

Mohammad S Razai, academic clinical fellow in primary care, Population Health Research Institute, St George’s University of London, UK.

Mona Kooner, general practitioner and educator, Chatfield Medical Centre, London, UK.

Iona Heath, retired general practitioner, London, UK.

Conflict of interest: none

References:

1. Alexander Dumas. Mes Memoires. Methuen & Company, 1907.
2. Alexander Dumas. The Count of Monte Cristo. Penguin Classics, 2002.  
3. Emily Dickinson. “Hope” is the thing with feathers. Poetry Foundation, 2020. https://www.poetryfoundation.org/poems/42889/hope-is-the-thing-with-feathers-314 (accessed 23/06/2020)
4. Public Health England. Beyond the data: Understanding the impact of COVID-19 on BAME groups. 2020. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/892376/COVID_stakeholder_engagement_synthesis_beyond_the_data.pdf (accessed 23/06/2020)
5. Vyas, D. A., et al. (2020). “Hidden in Plain Sight — Reconsidering the Use of Race Correction in Clinical Algorithms.” New England Journal of Medicine. DOI: 10.1056/NEJMms2004740
6. Moore A. Exclusive: Government censored BAME covid-risk review. Health Serv J 2020 Jun 2. https://www.hsj.co.uk/coronavirus/exclusive-government- censored-bame-covid-risk-review/7027761.article.
7. The Guardian. UK abandons contact-tracing app for Apple and Google model. 2020. Available from: https://www.theguardian.com/world/2020/jun/18/uk-poised-to-abandon-coronavirus-app-in-favour-of-apple-and-google-models (accessed 23/06/2020)
8. The Guardian. UK government ‘using pandemic to transfer NHS duties to private sector’.2020. Available from: https://www.theguardian.com/business/2020/may/04/uk-government-using-crisis-to-transfer-nhs-duties-to-private-sector (accessed 23/06/2020)
9. Salway S, Holman D, Lee C, et al. Transforming the health system for the UK’s multiethnic population. BMJ. 2020;368:m268. Published 2020 Feb 11. doi:10.1136/bmj.m268
10. Majid A. What lies beneath: getting under the skin of GMC referrals. BMJ. 2020;368:m338. Published 2020 Feb 12. doi:10.1136/bmj.m338
11. UK Government. The Lammy review: An independent review into the treatment of, and outcomes for Black, Asian and Minority Ethnic individuals in the criminal justice system. Available from: https://www.gov.uk/government/publications/lammy-review-final-report
12. UK Government. Race in the workplace: The McGregor-Smith Review. Available from: https://www.gov.uk/government/publications/race-in-the-workplace-the-mcgregor-smith-review 
13. UK Government. Windrush Lessons Learned Review by Wendy Williams. Available from: UK Government. Race in the workplace: The McGregor-Smith Review. Available from: https://www.gov.uk/government/publications/race-in-the-workplace-the-mcgregor-smith-review (accessed 23/06/2020)