The recent black lives matter resurgence has prompted a number of responses; from black squares on Instagram to large-scale demonstrations in most Australian cities. As a south Asian woman, I know I am not alone in finding this period of time perplexing. Racism can’t be reduced to a good/bad binary; it’s a systemic and structural issue. I’ve had to come to terms with realising that just because I experience racism daily, it doesn’t exclude me from being racist myself.
Why is it important for health care workers to be engaged with this issue? The answers are many. Adebowale and Rao summarise it succinctly in their recent BMJ editorial. Ethnicity affects pay, likelihood of bullying and harassment, inequality in service provision and is associated with disparities in health outcomes. Lack of diversity is associated with higher staff turnover and loss of productivity, whilst being inversely associated with patients feeling cared for.
There are plenty of resources that break this issue down and offer a world full of solutions. Here is my attempt at summarising a few, specific to the clinical environment in Australia.
1: The baseline assumption needs to be: “We are all racist”
Racism extends beyond the individual: it is not defined by the isolated acts of a few ‘bad’ people. It is a philosophy built into the systems that we live in, and it therefore follows that we have all developed racist attitudes and assumptions. To genuinely be anti-racist, it’s necessary to acknowledge our personal worldview and the reality that we are all racist until proven otherwise.
2: It’s not enough to read a Buzzfeed article. Real anti-racism requires action
There is little more condescending than someone reducing your lived experience of racism to a tweet, a couple of Facebook posts or the casual statement (“I’m not racist, I have heaps of Indian friends”). Here are a few practical ways to be anti-racist:
Donate to organisations that work for equality
- The first nations resource directory contains a useful repository of organisations that you can donate to. They range from indigenous youth climate networks and art projects to legal services, with a few health projects thrown in there too.
Amplify Black, Indigenous, and People of Colour (BIPOC) voices
- More listening and less talking is the name of the game. Don’t broadcast your own epiphany of racism; use the words of others who are actually experiencing it. This video is an extremely good example of what you should not do.
- Invite your local first nations people liaison to meet and speak with your department on a regular basis – not just a token once-off affair.
Increase ethnic diversity in your workplace, research and conferences.
- Ethnic diversity needs to be on the agenda if anything is to change. Start the conversation by tabling it as an item for your next staff meeting, remembering to base your discussion on the assumption that the system is already racist (see point 1).
- Actively seek out people of different ethnicities to be a part of your workplace, research group and conferences. Invite them along to be a guest speaker, an author on your next paper or sit at the table at your next committee meeting. Don’t just get them to be involved on projects about diversity; include them on projects that have nothing to do with the social determinants of health. As per the Australian Indigenous Doctors’ Association, increased ethnic diversity amongst staff in the clinical environment correlates with an increased level of acceptance of first nation doctors.
- If you are a conference organiser: be courageous and have targets for indigenous and BIPOC speakers. Gender equality is the first step in diversity but it’s not the last. At the CICM online education program, we have targets for gender and openly discuss the cultural diversity of our faculty and speakers. We’re also taking a deliberate step to include first nation speakers into our education program and have built cultural sensitivity into our curriculum.
3: Understanding lived experience is helpful
Which is where the many reading lists, podcasts and film come in. Some that I can recommend:
- TV shows
- Pretty for an Aboriginal
- Nakkiah Lui and Miranda Tapsell talk about their own cultural identify and how this fits into Australian society.
- Pretty for an Aboriginal
- Is there an Aboriginal bioethic?
- A great illustration of how our health care system is based on western ethics, and the importance of cultural humility
- Australian Indigenous Doctors Association (AIDA) policies
- If you’re into facts and numbers, AIDA has a number of policies that reference multiple studies of their membership base. It is incredibly sobering to read how many of our first nation colleagues have been made to feel that they do not belong to their own profession. I particularly recommend the “Racism in Health Care” policy.
- BMJ Racism in Medicine issue
- A very current and wide-ranging issue that explores the various forms of racism within healthcare.
- Is there an Aboriginal bioethic?
- The Australian Institute of Aboriginal and Torres Strait Islander Studies (https://aiatsis.gov.au/) website includes a range of research publications, profiles and summaries of key events in first nation history.
So there you go. I don’t claim that any one of these are a magic bullet. One thing is for sure – the solution requires different approaches, and each of them requires sacrifice on the part of those who are privileged. If the process leaves you feeling uncomfortable and drawing on your own humility, then you’re probably doing something right.
With thanks to George Drewett and Penny Stewart for their contribution to this article.
Dr Tamishta Hensman is an Intensive Care Registrar at Austin Health in Melbourne, Australia. She is founding member and co-chair of the College of Intensive Care Medicine (CICM) Online Education Program, Victorian CICM Trainee Representative and the IT Coordinator for the Women in Intensive Care Medicine Network (WIN). Portuguese water dogs, croissants and skin care are her other topics of interest.