Nycole K Joseph describes how her move to the US for medical training forced her to confront the brutal reality of racism in America 

Growing up in Saint Lucia, the mere possibility that the color of my skin could impede my ability to enter certain spaces was a foreign concept. Exemplary Black men and women surrounded me as I grew up, exhibiting their talents and skills across all spheres of life. I did not yet understand the sense of validation these individuals gave me, or how they shaped my sense of self and my capabilities from a young age. I did not necessarily visualize them as role models. At the time, it was simply the norm. 

Upon migrating to the US for subspecialty training, I anticipated having to adjust to a new environment; I had been educated on America’s racist legacy and was aware of how it continued to blight public life. Yet, despite this, I was still ill equipped to handle the extent to which interpersonal and systemic racism continued to disenfranchise Black people in America. I arrived in America as the same person physically, but was now seen differently. My Blackness entered the room first, and my other attributes followed. I went from being the majority to a minority and was very often “the only” Black person in spaces.      

My ensuing sense of imposter syndrome was overwhelming. I was navigating amid a dense fog, trying not to lose sight of my purpose for coming here. This was far beyond simply adjusting; it was an identity crisis. I lived not only through my experiences but also those of the friends I made, becoming more aware of the immeasurable adversity that Black people face daily while just trying to live their lives. Many of us have assumed coping mechanisms, strategically “code-switching” and lessening our authentic self-expression in order to adapt to our environments.      

Although a career in healthcare is rewarding, it poses particular, engrained challenges for people from diverse ethnic backgrounds. Black professionals often cite experiencing isolation, lack of representation within departments and in leadership positions, as well as inadequate mentoring and sponsorship to assist with career advancement and decision making.^[1] In addition to their professional duties, people from ethnic minorities are often taxed with carrying out diversity efforts—tasks that, in many instances, go without recognition or compensation.^[2-4]

Being perceived as inferior because of the color of your skin can leave you feeling wounded, an experience which is not uncommon among Black healthcare professionals who experience discrimination in the workplace and have to navigate the additional emotional labor it exacts.^[5-7] The reciprocal is prevalent, where Black patients continue to be pervasively marginalized because of overt racism and prejudice that is deeply rooted in the healthcare system. Conscious and unconscious biases, microaggressions, and lack of cultural competence from healthcare providers can result in misdiagnoses, inadequate treatment and counseling, and barriers in patient-physician interactions.^[8-10]

The current covid-19 global pandemic has had a devastating impact on the Black community, with disproportionately higher morbidity and mortality rates documented.^[11] This reflects wider, ongoing trends, which have seen Black people in America face some of the worst health outcomes.^{[12, 13]} These health disparities are in part attributed to limited access to medical care, differences in quality of care provided, and socioeconomic inequities—all of which share a common denominator: structural racism. Our mental health bears the brunt of the assaults from our community’s relentless battle with these injustices. This is compounded by the torment of witnessing a growing list of names of Black men and women killed unjustly at the hands of the police. 

I distinctly recall leaving the hospital after an overnight shift on 6 September 2018, when I was informed of the murder of my former schoolmate and fellow St. Lucian, Botham Jean, by a police officer who mistakenly entered his apartment. I find the circumstances, narrative, and outcome of this case bewildering to this day. In that moment I realized that by being Black in America, we are all at risk. Our nationalities, credentials, socioeconomic status, or the fact that we are simply human are disregarded because of our melanated skin. Irrespective of our different life journeys, we live in fear that our stories may be inextricably tied to one ending: the death of another innocent Black person. We dread becoming another headline or hashtag. I recognize that as a young, Black woman and essential worker, I could meet a similar fate as Breonna Taylor.      

Last year, as the world was placed on an obligatory pause in light of covid-19, an opportunity was afforded where all platforms and social media outlets could finally shed more light on institutionalized racism, economic inequalities, healthcare disparities, and police brutality. George Floyd’s final words “I can’t breathe” are symbolic of the knee of oppression suffocating Black people for centuries.

In 2020, the world was forced to pay attention and acknowledge the need for radical change. This year, with a new president and administration, we cannot afford to let this collective acknowledgement dissipate. We must allow these conversations and movements to continue and infiltrate every space. Silence during this moment is complicit. It is time to get the knees off Black peoples’ necks and allow us to breathe.

Nycole K Joseph is a native of Saint Lucia, currently in her final year of neurology residency at the Mayo Clinic, Rochester, Minnesota, USA. Twitter: @NycoleKJosephMD

Competing interests: None declared.

Acknowledgment: I thank Lea Dacy for her assistance with formatting this manuscript. 

References

1. Beech BM, Calles-Escandon J, Hairston KG, et al. Mentoring programs for underrepresented minority faculty in academic medical centers: a systematic review of the literature. Acad Med 2013; 88(4): p. 541-9. 
2. Campbell KM, Rodriguez JE. Addressing the Minority Tax: Perspectives From Two Diversity Leaders on Building Minority Faculty Success in Academic Medicine. Acad Med 2019; 94(12): p. 1854-1857.
3. Rodriguez JE, Campbell KM, Pololi LH. Addressing disparities in academic medicine: what of the minority tax? BMC Med Educ 2015; 15: p. 6.
4. Page KR, Castillo-Page L, and Wright SM. Faculty diversity programs in U.S. medical schools and characteristics associated with higher faculty diversity. Acad Med 2011; 86(10): p. 1221-8.
5. Cottingham MD, Johnson AH, and Erickson RJ. “I Can Never Be Too Comfortable”: Race, Gender, and Emotion at the Hospital Bedside. Qual Health Res 2018; 28(1): p. 145-158.
6. Paul-Emile K, Smith AK, Lo B, Fernández A. Dealing with Racist Patients. N Engl J Med 2016; 374(8): p. 708-11.
7. Whitgob EE, Blankenburg RL, Bogetz AL. The Discriminatory Patient and Family: Strategies to Address Discrimination Towards Trainees. Acad Med 2016. 91(11 Association of American Medical Colleges Learn Serve Lead: Proceedings of the 55th Annual Research in Medical Education Sessions): p. S64-S69.
8. Chapman EN, Kaatz A, Carnes M. Physicians and implicit bias: how doctors may unwittingly perpetuate health care disparities. J Gen Intern Med 2013; 28(11): p. 1504-10.
9. Hall WJ, Chapman MV, Lee KM, et al. Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. Am J Public Health 2015; 105(12): p. e60-76.
10. Cruz D, Rodriguez Y, Mastropaolo C. Perceived microaggressions in health care: A measurement study. PLoS One 2019; 14(2): p. e0211620.
11. Golestaneh L, Neugarten J, Fisher M, et al. The association of race and COVID-19 mortality. EClinicalMedicine 2020; 25: p. 100455.
12. Kaiser Family Foundation. Key Facts on Health and Health Care by Race and Ethnicity. 2019 [cited 2020 9 September ]; Available from: https://www.kff.org/report-section/key-facts-on-health-and-health-care-by-race-and-ethnicity-health-status/.
13. Evans MK, Rosenbaum L, Malina D, et al. Diagnosing and Treating Systemic Racism. N Engl J Med 2020; 383(3): p. 274-276.