Hello everyone, my name is Hani. I'm a newly qualified doctor from London
... why I suddenly just decided to be a YouTube fave, but, here we are
'You're not about to get on this flight sis.' I was interrogated for just under two hours
[Joyful cheering, music]
(Music: Mayday - Crush ft. Joy)
I didn't think I would film a video like this, but I just thought it would be remiss not to
given kind of what's been going on at the moment and given that I am... I wanted this channel to be
one where I talk about
skincare largely for people of color - I'm really interested in hyperpigmentation
especially periorally, periorbitally
But given that health and beauty are intrinsically linked
And given what's going on at the moment, I just thought it would be remiss of me not to discuss that to some degree
And if I just kind of start on a personal note
The reason I decided to study medicine was because I wanted a safe space for people like my mum
My mum would always ask me to come to the doctors with her if she ever had an appointment and I used to find it really annoying
but because she speaks decent- like it's not a hundred percent perfect but she speaks  pretty fluent English
and obviously she could literally be fine to go to the doctors by herself
But she said she felt like she wouldn't be taken seriously and as I got older like I really began to understand why.
I rang the GP the other day for her and I was literally -
the receptionist was having a go at me telling me that I couldn't -
Like just the requests that I'd made she was saying no we can't do that
That's not a service we offer even though I know they offered that service
and she hung up on me and I
redialed and it wasn't until I said I was actually a doctor that she apologized and start taking me seriously
And the reason I was so reluctant to bring the fact that- I've literally been a doctor for like five minutes
But the reason I was reluctant to bring that up was because like most people can't bring that up
But the service should be appropriate for everyone
It shouldn't be that
because you have an insight into the system people are going to be more seriously or more credibly and
Actually in the middle of my medical degree I actually took a year out and I did a master's degree in
Looking at ideas of pain and Blackness and
Looking at the association or the perceived association between Blackness and madness, the instability of the Black body, things like that
And I really began to see how a lot of these small -
microaggressions these small
experiences that are unpleasant that we have whether as a receptionist being rude to us on the phone, all of these things are
rooted in
epistemic injustices that do exist and a lot of this is enshrined in the kind of racist attitudes that do
pervade our societies. There's syndromes called 'Mrs. Bibi syndrome' and 'Mrs.
Begum syndrome': Bibi and Begum are very like stereotypically Bengali surnames and 'Mrs. Bibi Syndrome' is a syndrome where
elderly women - in that example from Bangladesh -
but generally they kind of are referring to like an ethnic old woman who's just complaining of this pain - complaining of random pain
Where the pain is thought to have no organic cause, so there's no actual organic thing that's causing the pain. They're just complainers, you know
but actually
in the example given in a paper that discusses this
The writer made a really good point about how as soon as you brought a translator in the generalised pain
that was really non-specific was actually like I don't know very
specific pain in her ankle which ended up being gout. I've made the result up
but it was proven that actually a lot of the time
what you're brushing off actually does have an organic cause and you're not investing the appropriate time and labour to establish what it is
Notions around Black skin being tougher
and having fewer nerve endings
There was a
meta-analysis - a meta-analysis is when you look at loads of papers and you analyse them all together and you exclude the ones that are crap
like maybe they didn't have enough
protocols or controls or the samples were too small - you look at all the ones that were done properly,
you put them together and you come to an overall conclusion and this
meta-analysis found that like around I want to say 50% of
medical students thought that Black skin was tougher and had fewer nerve endings and that Black people couldn't feel pain as much
and like that's
obviously horrible but also I guess unsurprising when we think about how
Black women
often have their pain neglected and are much less likely to receive pain medicines and how doctors think they're
likely to be malingering:
so when you have a patient who's just like annoying you and just making stuff up because 'they want their fix of
pain relief medicines', like they're addicted and obviously that's not the case. In psychiatry, there's a
potent
association between Blackness and madness to the point where these
associations were probably actually just created de novo that just made up to
sanitise the colonial project and to give reasons for it. Like, 'yes colonisation -
like the scramble for Africa was good because Black people are wild they're primitive
they need civilisation and genteel order to be brought to them.' And so there's loads of
pseudoscientific papers which were published as scientific papers and still exist today
where they say freedom was
'pathological for Blacks' and bondage was salutory so bondage actually like
'enslavement actually helps their mental and physical condition' and freedom was pathological for them.
And the thing is obviously you might think those are relics of the past but those same
pseudoscientific ideas still exist today
like they're still -
remnants of them, the knowledge that was produced in that era based on those things still exists today
So if we look at the estimated glomerular filtration rate, which is one of the ways we measure kidney function.
It assumes in the calculation
it factors race in the calculation and it assumes that Black people are more muscly and
because of that it means that Black people have to have a higher bar of kidney damage
before the results will pick it up. Because it's already allowed for like increased muscle mass and increased muscle mass
does actually have an effect on your kidney filtration.
But why would you assume that Black people have increased muscle mass?
Like I - not to use myself as an example, but like my muscle mass is like
shocking and
obviously you do just get white people and people who aren't Black who are very very muscly bodybuilders, etc. So,
And it just like why and and if we and if we specifically think about like Black people and having more muscle mass like -
What do you think, like Black people are - I don't know if anyone remembers the video like ages ago never scare a Black man
just things like that where you just think like Black people are violent and rugged and rough and
super-strong and whatever it's just like all of that is just all these myths around Blackness are just like very worrying and scary to me
And they still exist in in medicine and healthcare
And it kind of goes beyond that like all these diseases we learn about all these skin conditions
We learn about like Kawasaki disease, which is a vasculitis of blood vessel inflammation that happens to children
There's like no pic- there's barely any pictures of that on on
Black people and the way the rash is described - it's described as an erythematous rash
Erethematous means red - Black people don't really go red
Even things like Malar rashes - a rash you get on your cheeks in
Something called mitral stenosis, a heart condition, or you can get it in lupus
It's called like a red butterfly rash, but it's not gonna be red on a Black person or a person with dark skin
it's gonna be a purpley color and it's really like - I've looked for pictures of these
I haven't seen them and I actually had a friend who was
she was on like a
Exchange medical thing. I don't really understand but she's from Zimbabwe and she was she saw a malar rash here and she was like
Oh my god. Wow, it's actually red, it looks like the pictures and I remember asking her like oh my god
Yeah, like how was it in Zimbabwe?
And she was like, yeah, it was purple, you know
And she didn't she was like it was a so novel for her to see that
Actually, it could look how it was in the textbooks because where she was from like obviously it doesn't - everyone was Black where she was
in general a lot of these clinical descriptions of like
yellowing of the skin or erythema. So the redness
or pallor - paleness or cyanosis - blueness?
They're not
applicable to people outside of that white normative reference point
And it honestly scares me to think how many people will have died from the misrecognition of disease because of their skin color
And the reason I'm bringing that up is because in my personal experience obviously explained how I wanted to kind of champion
people like my mum in the clinic, so I wanted to like, you know, just fresh people,
people who don't speak English that well
I really wanted to be a person who
could advocate for them in the hospital, in the GP, like for them to know that they had like
someone in their corner, but I'm realising that on a systematic level
I'm still being undermined. We're still being undermined so even in spite of my efforts, like, I as one person can't
overcome systematic failures even um
When I did blood tests on some of the Black patients I had I noticed a lot of them had low white blood cells
which was seemed a bit concerning because normally low white blood cells is associated with like
What's it called?
Immunosuppression
And things like that so like no, it's not normally a good thing to have lower blood cells
but I noticed it in a lot of my Black patients and then when I did some reading I found that actually
Black people a lot of them do have leukopenia. A lot of them do have white blood - low white blood cells. I'm like why?
That just raises even more questions. Why do Black people have low white blood cells?
Why is it just brushed off as a racial variant? Like why have we not analysed this?
Does it mean our immune system functions differently - because it's not a thing where Black people get disease more easily than people of other races
So like that actually creates a lot of questions
Immunogically, do we function in a slightly different way? Also things like Lyme disease - Lyme disease is a disease you get from tick bites
And they thought that Lyme disease manifested much more aggressively in Black patients. So things like kidney failure, multi-organ involvement
whereas white people had like a much milder version of the disease
But they realized that the early sign of - so the early sign of Lyme disease is a rash called erythema migrans
It looks like a bullseye, people also call it a bullseye rash, but if you googled Lyme disease rash
Like literally I'll try and insert a screen-recording
Literally every single picture of it is on a white on a white person's skin
[Jeers]
And because of that someone realised in 2000 like actually,
maybe Black people don't have a worse version of it. Maybe we just don't pick up on the erythema migrans
And so when we do figure out that they have Lyme disease it's at a much later stage and they've got much more advanced disease
But still like I Google obviously literally the screen recording I'm gonna insert is today
You can see that no one's addressed this still. Like it's still a problem
And I honestly like it makes me scared to think about how all of these reference ranges when comparing blood values are
based on white skin
even things like peak flows when we measure your lung capacity and things like that are based on white skin. Drugs largely tested on white people
It's actually like a lot of the drugs that Black people are taking aren't tested on us
and I did see paper a long time ago where I saw that East Africans have
fewer of a certain type of receptor and so some painkillers they actually have to take
more of them to achieve the same effect which which then says that East Africans taking that medicine would have been
dosed sub-therapeutically so at a level lower than they needed for a very long time
and so we're literally taking drugs that haven't been tested on us, reference ranges that are based on like
The aren't based on Blackness are been used or like ethnic minorities and so you realise that like well
I realised really sadly that the thing that I thought I wanted to do where I would like advocate for like
marginalised people I realised that there are loads of systemic failings going on that I can't overcome
saying that though when I did my GP rotation while I was at medical school
I was like the family doctor and people would come and see me
I had so many patients who literally like would take a picture of my ID card and say I'm only asking for you next time
And like so many people had so many lovely kind things to say
And like I even think about it makes me really like, I don't know. It's just it was a very, very nice thing
I can't help but think that like is that because you finally had someone who could like engage with you on your terms
and things like that and really listened to you and
gave your words credibility.
So yeah, I don't really know where to - like where does one begin?
In fixing this problem because it's not about individuals. It's about
collectivising
The understanding that the knowledge production that was used to create a lot of the medicine that we understand was
foundationally racist
And I'm still figuring it out, hopefully, so obviously it's about
making sure that people can identify and unlearn their biases but at an institutional level like how does that happen as well?
hopefully
I'll be able to figure it out at some point, but it's not again - it's not an individual thing. It's not just about me
It's about everyone. It's about a collective which is why I've really wanted to make this video
I've really just rambled. I hope what I've said has made
sense
and yeah, like
Obviously I was - I am really interested in skin care. I do really want to make videos on that but
the reason that I feel the need to do that in the first place and the reason that I would love to one day have
a skincare line for people of color is because
again, like I feel that our
our issues with skin and skincare have just been sidelined left on the back burner
because it's not anyone's priority until they can find a capitalist agenda for it
And we did see that with Black hair care. So Black women actually spend the most
dollars like per person if you divide how much they spend on hair care per year
It was the most by far like literally by far far outstripping any other race and gender
 
and obviously like no one cared you still if you wanted to buy Black hair products
you still would have to go to like a specialty Black hair shop until the big brands
realized that there was money to be made and it wasn't until very recently
that you could buy products for Black hair commercially. And even now I'm seeing pictures on Twitter of the Black hair care is like behind
glass doors and like
security tagged and locked and the white hair care stuff is out. And obviously the same way skin care for people of color and Black people
should be a thing as well. Like we have slightly different needs
some of our issues are things like overactive melanocytes
cause increased melanin production and deposition and things like that
And are not things that affects people with like fairer skin so that I don't know like if I wanted to buy sunburn lotion
Then I can just buy that in any
drugstore, chemist, whatever
But I wouldn't be able to do the same for like a thing that affects all Black people all people of color, you know
Like hyperpigmentation, which I think is a real shame
The reason I realised actually I do have to speak out about the rest of it is because you can't divorce health and beauty these
Things are intrinsically linked
So I just wanted to offer my perspective on that
You know
I honestly feel like I've barely scratched the surface like I did a whole master's degree and
like countless essays looking at a lot of the racism that exists in the healthcare system
But I hope you found this video informative
In general, I find a lot of the attitudes of people in medicine and healthcare generally like really scary to be honest
like
there's a lot of
Saviour and God complexes and things like that and I feel like a lot of people of color suffer as a result
especially because in the clinic the power asymmetry is really crazy because
all of the terms
all of the language of medicine is like
super super jargon heavy like if your potassium is high it's called hyperkalemia
Like everything just sounds really complicated when sometimes it's not that complicated
So you've got no purchase. You've got no way of understanding what's going on
You tell your doctor things that are private that you might not tell people in your family. Like they literally know like your secrets
And you don't get anything back, you know, I mean you - but if anything you call them doctor, do you know what I mean
You acknowledge their superiority in a sense by saying that
Which is why I like how in the UK actually a lot of time you'll call your doctor by their first name like it's not a thing
Where you have to call them doctor because I've seen tweets in America where people were saying you have to - anyway
more on that later
Yeah, so you literally tell them your secrets and private things that you wouldn't tell other people
you have no way of understanding what's wrong with you except for with their help and with their
generosity
What's at stake is literally your life and
So I think you are in a sense, set up to fail. You are at the mercy of this person and I think
I don't know how to
thwart that power asymmetry - is it necessary. I feel like it's not but I don't see practical ways around it
and so at the very least I feel like the healthcare provider should be someone who
wants to - as far as possible - be someone who is worthy of that privilege
So make real and concerted efforts to unlearn your biases,
to listen to your patients, to ask them what they need from you, to ask them how you can help, to ask them like how
Can I help you? Like what can I do for you -  in a sincere way.
And I just don't think that happens, in any way, shape, or form and it is really, really disappointing to me
Yeah, sorry, that was really gloomy
I'm actually like quite a cheerful person and hopefully but this is inherently like a depressing topic in that like this is our reality
And I haven't even scratched the surface on - as a
healthcare professional who is someone of color like the specific
injustices we face on a daily basis like I haven't even gotten into that
and hopefully maybe I'll never get into that but
nonetheless, I hope you found the video informative. Thank you so much. Please like and subscribe if you found it helpful
And if you have anything you want to ask please do leave a comment as well. Thank you so much, bye!
 
