Racism in Health: A Patient Safety Issue? Mine and my family’s experience navigating healthcare: Part 1

Snap shot of racism issues raised in the last few weeks.

The last couple of weeks and days has highlighted the issue of racism in the NHS against Black African healthcare workers as shown above in a limited snapshot not to mention the fact that the COVID19 pandemic has also highlighted the health inequalities experienced by Black, Asian and Ethinic Minority people in the UK, be they patients or healthcare workers.

While we have grown vocal in calling out these inequalities and racist practices within the NHS and as black african healthcare workers we have developed systems amongst ourselves to help us cope within our own work environments, where we warn each other about certain colleagues or wards and what to do if you find yourself in an uncomfortable situation. In a sense inorder to continue working, we have had to develop so called thick skin, but what we have forgotten is that these racist colleagues, who more than often are in senior positions or authority, be they senior nurses/midwives/matrons, clinical nurse specialists, practice GP nurses, GPs, hospital consultants or even junior doctors also look after patients and make decisions on behalf of patients who look like us, the colleagues that they are racist or biased against, i.e Black African and their racist attitudes affect the care these patients receive!

Nursing while black on the NHS is a skill i had mastered but nothing had prepared me for being a patient while black on the NHS and how the system is stacked against you and how lonely, frustrating, anxious, helpless and dare i say angry you feel while also wrestling with the guilt of essentially raging against your employer and not wanting to cause a fuss because it is the NHS, you love the NHS, you are constantly reminded how lucky we are to have the NHS, so it would be in very bad faith to complain.

Most of the racism and appalling care as a result that i have experienced as a NHS service user has been via their maternity services where i felt that was always viewed as an oppressed, uneducated Muslim black African woman who should be grateful about receiving any care at all, and it came as no surprise to me when statistics show that Black mothers and their babies are more likely to die or be harmed while accessing maternity services! While all experiences have left their mark, one way or another, there is one particular one that has had a lasting effect trauma and health wise not only for me but for the whole family.

After a couple of years of being married and not a getting pregnant, despite having had a child, who later died at nine months in a previous marriage, our doctor made a referral to gynaecology and after some tests, we got referred for assisted conception and funded for 2 cycles. The first cycle resulted in over stimulation of my ovaries which resulted in having to have regular scans just to make sure none of the eggs burst.It was during one of these scans that we discovered that we were pregnant. At 35 weeks my water prematurely broke and i was advised to come in for an assessment. It was late in the afternoon when a decision was made to admit me as i had lost almost all of amniotic fluid and i was to be induced. I was handed over to 2 South Asian midwives who were not too pleased at the prospect of looking after me and between their bigoted selves, within earshot, decided that they would pawn me off to the male midwife who was coming in later for his shift. So i sat in the waiting room until Andy, came on shift and he cottoned on as to what was happening and proceeded to inform them that, i will be his only focus throughout his entire shift and he was brilliant and stayed with me through out the failed induction up until an emergency cesarean had to be performed and at then handed me over to the postnatal team and to the worst care ever! I was alone and in pain in a side room having had surgery, with a premature baby on a temperature regulating cot. My call bell was never answered and was switched off at the midwives station and when i mastered the strength to walk to the midwives station to ask for some milk for the baby as i could not breastfeed, i was told that i was to bring in my own! So i called my husband who then brought it the bottles steriliser with some bottles and a some formula milk. No one came in to change my sheets or make the bed or even clean the room, so the first day i changed rotated the blood stained sheet from top to bottom. Day 2, was shouted at by a midwife ( afro-Caribbean) , who proceeded to call me ‘ you filthy people’( not sure if she meant us Muslims, or black Africans! ) because i had been sponge bathing as no one had told me i could have a shower given my surgical wounds. She continued to berate me about not showering and how my lack of personal hygiene would cause me to have a infection then proceeded to rip the bandage off and order me into the shower! At this point i was just bone tired and saved my tears and frustrations for visiting hours when my husband came. On the 3rd day which was a Monday, the ward manger( White lady) came into my room while i was making the bed, this time using the top sheet, that was less stained as the bottom sheet, and she was shocked as to why i was making my own bed while i should be resting and why on earth i had a bottle steriliser in the room? I told her it was because no one had been in to change my bedding since i had been put in the side room and that i was told i had to provide my own milk and bottles as the hospital didn’t provide any! She immediately got clean sheets, made my bed and told me the hospital did provide milk and proceeded to get several bottles for me. I just sat here and cried and later that day i got discharged. My husband wanted to put in a complaint but i discouraged him, telling him that the NHS was wonderful and caring and that this was just one bad experience. It was the health visitor, who later picked up on how that experience had really affected mentally, especially given that i had lost a child previously and she would go out of her way to support me mentally, by suggesting walks with her and the baby, keeping a dairy of how i was feeling and also provided a symptom diary via CONi PLUS scheme that helps bereaved parents care for subsequent babies.

We fell pregnant again after four months, and there was concerns that because it was so soon after my cesarean section, the risk of a natural birth was high and that i would probably have to have another C-section. Due to family reasons we moved from London to the West-Midlands so didn’t have the same antenatal team that knew my history and looked after me. I soon found out that things in the midlands were done quite differently and there was not much support. At 37 weeks i went into labour and called the labour ward but was advised to only go in once my contractions were closer together ( no mention or worry about uterine rupture/ trial of scar) , by the time i got to the labour ward, i was bearing down and was promptly taken to a delivery room where the midwife was in no rush, so i told my husband to be ready to hold the baby as it was coming. Just as i was crowning, the maternity support worker burst into the room panicking and shouting that my online records had an alert on them and that i was not to deliver without a whole team being present which included an Obstetrician and a paediatrician, which made sense as i was a high risk even for trial of scar and could quickly bleed out, a fact that didn’t seem to bother the lone midwife who was in the room with us! By the grace of God, i had a normal delivery and went home the next day. There was no mention from anyone within the healthcare team about the near miss that had occurred. Once again, my husband thought i should say something but once again i declined, citing that maybe because i had moved they didn’t have all my records and the NHS is great and all had ended well.

You know how you wait for a bus and then 3 come at once? Well someone had turned my life into one of those bus analogies because four months later we were pregnant again! After the shock and lots of tears, i finally embraced the fact that i was going to be a mother again. 1 was assigned a community midwife and things seemed to progress well. 8 weeks or so into the pregnancy i started spotting and called my midwife who advised me to go the local hospital emergency department as she was off duty, so that i could be checked out. Later that afternoon after my husband had come home from work, i asked if he could look after the kids while i popped into hospital for a quick checkup. So i walked to the hospital emergency department, got checked in and waited to be seen. An hour or so later i was called in to see the doctor. I explained why i had come in at the recommendation of my midwife. He then told me that it was not hospital policy to admit cases like mine but since it was his last day at the hospital as he was moving to Newcastle where his dad had bought him a house, he would admit me so that i could have a scan to see what was going on. But before all that he needed me to provide a urine sample so that a pregnancy test could be done to confirm pregnancy. As i was giving the sample a stream of blood came out and i informed him and he then said i should wait in a cubicle while he sort opinion from the Gynaecology team. After a very painful examination by the gynaecology doctor who confirmed presence of products of conception, i was transferred to the gynaecology ward. it was a rocky ride by internal ambulance to the ward block and eventually onto the ward and immediately i got onto the ward, i had this sharp lower abdominal pain. I was allocated a bed and assigned a student midwife who upon taking my vitals noticed something was wrong and i was switched to the bed across as it had an oxygen point. I was feeling really faint and breathless. The nurse in charge bleeped the doctor who finally appeared after an hour or so at which point i was in increasing pain and very breathless. I decided to advocate for myself this time and went on to inform him that i thought i was bleeding internally and that maybe he should carry out an abdominal tap to check. His reply was that, such procedures are only done in third world countries! He then left with the plan that i should be monitored more regularly. The next thing i remember after is the overwhelming pain i was in and the feeling of drowning, at which point the doctor had been bleeped several times and had not bothered to show up and i remember the charge nurse shouting and threatening legal action if no one came . I was now being cut out of my clothing. Then everything went blank. The next part is now told through my husbands witness experience, who upon waiting for my return home, got worried that something had happened, put the kids in their double buggy, went up to A&E and tracked me to the ward where upon arrival, i was being resuscitated a third time with an abdominal tap being carried out and blood spilling and the consultant shouting as to why it was let to get to this stage! While he was standing there confused and scared, they managed to bring me back and told him that they had to rush me to surgery as i had lost almost all my blood and that they were not sure if they could save me but they would try. He was asked to leave but he refused and said he was going to wait whatever the outcome. He sat there waiting and witnessing while lots of blood had to be blue lighted in, wondering how i had left him at home only hours ago, walked to hospital and now was likely to die because once again somebody somewhere had decided that i did not matter. Hours later the consultant came out, scolded the doctor in their language ( both south asian ) then went on to inform my husband that they had managed to save me, and had to take out my right falopian tube and that the surgical site is not pretty as the had to cut into me very quickly given the emergency. I was later transferred to HDU and later on back to the ward i had originally been admitted to. Here i was again looked after by the student midwife who had originally been assigned to me. No one ever came to apologise or explain as to what had gone wrong. On discharge day, the student midwife wheeled me to the lifts, and told me to stop getting pregnant as i was killing myself and that i needed to go on some form of contraception! Years later, i still have that discharge summary with her signature on it. I was to go to my GP surgery to get the staples removed in a couple of days.

On the designated day, i went to my GP surgery as asked and was taken in to wait for the practice nurse. This nurse was very annoyed and kept asking me why i had come to the surgery and why i could not have gone to the hospital to have my staples removed? She also wanted to know why the hospital had not given me a staple/stitch remover? She left the room in a huff, came back and continued to tell me how she only had one stitch/ staple remover which she was now going to have to throw out once she had used them on me! At this point i was trying soo hard not to cry or give her the satisfaction of seeing how her tirade was affecting me. I lay on the couch as instructed and she went to use as much force as she could muster to pull out the staples and when i made a wincing sound, as all this was very painful, her response was, what did i expect! it was meant to be painful.

That was the end of this chapter for all the healthcare team involved. We will never know if they continued to put other mothers lives at risk, if they went about their work or indeed if the still go about their work with their racist and biased views unchecked. I probably played a part by not calling out their actions. As a family we still live with the trauma inflicted by their actions and inactions and the health complications that have since followed. Years later, my husband and i are sat down in the evening watching Grey’s anatomy and it’s the episode where Meridith Grey is in and out of consiousness due to COVID and she is on a beach with Derek and O’Malley, and my husband takes my hand and quietly asks, “how was it? “ and it takes me a moment to realise that he is asking about how i felt when i had to be resuscitated. I tell him i really can’t remember and he squeezes my hand with tears in his eyes and says “ i have never prayed as hard as i did on that day” .

That is why i am glad that campaigns such as Fivexmore exist and launched the Black Maternity Experience survey and are “ Committed to Highlighting and Changing Black women’s Maternal Health Outcomes in the UK.” Visit their website: www.fivexmore.com to see more of their great work.