Jun 4

Jun 4 Racism and Inherent Bias in Health: A Patient Safety Issue? Navigating healthcare while Black: Part 2

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

Growing up, going to hospital was a very serious affair. It often meant that one was very sick or that something was very wrong. You would often get people going to visit relatives or friends to check on them because they heard they had gone to hospital. I have often joked that we Africans only seek medical help or go to hospital when we are dying ie when things are serious! Other times we relied on herbal medicines and remedies or over the counter medication and just got on with life. I had not realised that this ideology was deeply rooted in myself, why go to hospital when a paracetamol here, an ibuprofen there, a little Vix/Rob could help ease the pain, plus there are more sick people in the world and so long as the pain was bearable, life went on. In fact I took pride in the fact that i was not a frequent visitor to the GP and surely that alone must have earned me brownie points and that if I finally came in for a consult they would look at my records and see that I had not been in to see them for near on 11 years and that for me to have come in, means things were serious- the dying African analogy thing! I mean my work sickness records matched my not visiting GP records, if that earned you brownie points at work surely it applied to my GP as well? How deluded i was! But before i explain my delusion and crash to earth moment, i need to highlight another issue that in my opinion is a huge determinant in the quality of healthcare we receive as Black and marginalised communities. These are my observations and experiences through the years and by sharing them i hope i start a conversation where we as individuals can look within ourselves and check our biases and maybe we can understand that sometimes the system is stacked against certain individuals making them invisible and that by the time they become visible, it is not because they were neglectful with their own health or that they did not try hard enough, it just got too exhausting trying to get the help they needed and finally they gave up and that those racist views and practices at the top that we constantly deal with at work, school, in life, have a knock on effect that then affects society as a whole.

Before moving to Birmingham in 2005, we lived i a quiet mainly white neighbourhood within a small town. The GP practice was a small family practice with a handful of doctors and a lovely pair of receptionists who even while talking to you in person or over the phone, getting more information before sign posting you to the right service, did it with kindness and patience more often than not. You always felt welcome, never rushed and every concern was dealt with in house or via referral. Slowly the town started to grow, the independent shops were knocked down, a huge Tesco was built and new apartment blocks started springing up and the GP surgery got busy. The town was growing and changing, a natural progress. The area we moved to in Birmingham and indeed Birmingham as whole was much quieter and laid back than London, the traffic was almost none existent, it seemed like by 12 midday, especially on weekends everything just died, it was way to quiet but on the up side we could afford a bigger house with garden and the neighbours seemed nice. We registered with the local GP surgery, which was almost like the one we had left in London, despite the incident with the practice nurse or occasional gaffe by one of the GP partners who upon seeing the children during a consult said: “ what fat children! Very different from the ones I have been seeing in South Africa this last month” ( She had just come from a volunteering programme in South Africa), overall you felt heard and more importantly you saw your named doctor and the continuity of care was there. The receptionists were kind and you could walk in to make an appointment . The streets were clean, we knew the local street cleaner and would stop for a chat once in awhile. A year in we started to notice for sale signs cropping up, the white folk in the neighbourhood were moving out. Not long after, the local street cleaner left, said he was retiring and for a week a two we had a replacement and then nothing and they would be cleaned as and when. The area started to look neglected and derelict. Various take away shops started to crop up. Our corner part of town was changing and growing and not for the better it looked and the GP surgery was not spared this growth. We were getting an upgrade, a bigger and better service, it looked like but looks can be deceiving and not all change is good, especially when an area is changing and becoming more derelict and unkempt and phrases like ‘ deprived area ‘ start being banded around. When an area is now mostly inhabited by marginalised communities and it looks like the local council has all but given up and services such as litter picking, rubbish collection, housing and the community surroundings as a whole take a back foot, you start to realise how all this connects to healthcare provision, schooling, policing and life in general. A two tier system comes into play.

A year after my life altering surgery, i was back at work navigating the pitfall that is the extreme sport of nursing while black, especially in a new town, environment and work culture and all the changes going on withing the neighbourhood largely went unnoticed or took awhile to notice as most of my time was spent at work and the only time i went to the GP surgery was to take the children for their immunisations etc. I had been told at my hospital outpatient follow up after the surgery that i would experience some lower abdominal pain which was normal due to scaring and so i managed my pain when it became unbearable by taking paracetamol and ibuprofen and occasionally buscopan. My local pharmacy was great and between myself and the pharmacist we always managed to puzzle stuff out which meant i was helping the GP service as well as the hospital service by not using up time that can be used by more urgent cases. Years went on and the pain slowly got worse but i put it down to scaring and work/ family pressures. More and more people were coming into hospital and complaining about their GP’s and access to services, from rude receptionists, seeing different doctors if you were lucky to be granted an audience and no continuity of care, it was easier to come into A&E. One chap had been to his GP ( one of those mega practices) several times complaining of chest and joint pains and each time his was given pain killers, then stronger ones which were eventually on repeat prescription! After a year of frustration and increasing pain and breathlessness he turned up in A&E and was diagnosed with TB. Another elderly chap had to go into A&E at the request of his GP’s receptionist at the frustration of the A&E doctors. His old GP had retired ( White Exodus) and the surgery had been taken over by another GP ( South Asian ) who only operated on a Thursday and worked the other days at his brothers practice in Solihull. This meant that his patients could only book appointments to see him on the Thursdays otherwise if they fell sick outside of that given day, then A&E was their only choice! He finally had to change GP’s to a bigger practice, when it took almost 4 months to fix a medication error with his diabetic medication, where he was previously on a combined tablet of Metformin 850mg/ pioglitazone 15mg but later changed to standalone tablets but with Pioglitazone at 30mg, when this error was later highlighted to the surgery( taking months to sort out) , the only explanation was that the standalone tablets were cheaper than the combined tablets! No recognition of the drug error/ potential harm caused to patient nor an apology. This is what care in a so called ‘deprived’ area had come down to!

After more than 11 years since my major surgery and managing the related pain on my own, it got to a point where the pain was massively affecting my quality of life. So i decided to seek the services of my GP to help find out why the pain was getting worse and also why it was mainly on the left side and not the right where the Fallopian tube had been taken off, also why i was needing to empty my bladder more often. My GP practice had under gone a huge change and had become one of those major practices with around 8-10 doctors. It was a mission getting an appointment and i was informed that i would see a duty doctor as opposed to my named GP as that would take weeks of waiting. So i turned up for my appointment with my husband ( he was not letting me go to hospital alone ever , since i almost never came back last time he did) , the doctor asked why wanted to see him, i told him i had given all that history to the receptionist but i could tell him again, so went to explain why i was there to his completely disinterested self. He then asked what is it i wanted him to do? and that i had been dealing with it for 11 years, so what did i expect him to do? I was stunned into silence, i tried to explain that yes i had been dealing with the pain for that long but i had come in for help because it was getting worse and affecting my quality of life and my work as well and that something didn’t feel right and that if he looked at my records he would see that i was not a frequent visitor to the surgery and that the fact that i had come in meant that i was not coping and needed help. He casually googled the medical term for ovulation pain, then proceeded to tell me that i was suffering from that and that i should would write me a prescription for Ibuprofen which i should try and that would sort out my pain and that i can not expect him to help me when i have no records and do not seek help and that if i need help i should fight for it and bang the door more and then i would be taken seriously as they would then wonder why i was frequenting the surgery and was not getting help/relief from interventions prescribed and so would take matters further. in other words, i had to be a problem patient to be taken seriously! I was gobsmacked and just sat there starring and not believing what i was hearing. I could see that if i stayed and continued arguing my point the situation would escalate into something serious, so we left. I don’t know who was more livid between myself and my husband.

I could tell you how after weeks of banging on proverbial doors I finally got an ultrasound and MRI scan, which showed fibroid growth and bulging disks, further banging led to useless misogynistic gynaecological referral and a most eye opening Orthopaedic appointment where I was being warned to look out for signs of Cauda Equina and to get myself a female gynaecologist. At this point I was just tired 😫. Not that the story ends there nor does my experience of bad healthcare even after changing Gp's ( still same area with super surgery ) and i’m sure mine is not the only story of struggle in getting proper healthcare as a black person not to mention as a woman ( indeed the black practice nurse at my new surgery was leaving due to racism at the surgery! Not to mention that a serious drug error almost occurred because my records had zilch on them, no one had bothered to populate my online GP records! Being a nurse saved the day.)

Historical and all through colonialism with attitudes that still extend to this day, Black people have always been at the bottom of any hierarchical structure, our value and worth was and is still considered below that of the Whites and South Asian and these biases exist in everyday lived lives of Black People no matter your standing in life. How many black Owned and led GP services are out there? I am yet to see a black doctor at a gp surgery! Maybe if there were it would at least be a start in evening out the playing field of healthcare navigation for black patients? Just a thought. All I know is that i’m tired of constantly fighting to live while Black, be at work, I'm school/University, access to healthcare not just bare minimum healthcare and tired of being blamed as a whole for health outcomes while the system is verily rigged and stacked to the rafters against any positive outcomes.

Meanwhile, when you see me at the hospital looking alot worse for wear with conditions that could have been treated had they been caught earlier, please don’t fall into that judgmental trap of “ why are these people so neglectful with their health while it’s free” ! Try to listen and get their story, you maybe the only one who cares enough at that point!