Racism in health care is a rampant problem. Not only do doctors specifically not believe Black people's pain to the extent that they believe the pain of white people, but they aren't trained in how many conditions and diseases show up on darker skin.
That's where Malone Mukwende comes in. Malone is a medical student at St. George's University in London. He noticed that all of his training focused on the signs and symptoms of disease on white skin only. So he decided to do something about it. He created Mind the Gap, a handbook specifically to teach medical students and doctors clinical signs in black and brown skin.
“But what will it look like on darker skin?”- A question I’ve often asked myself during my time at medical school— Malone (@malone_mk) June 18, 2020
This constant cerebration led me to curate a handbook that presents clinical features on darker skin. I hope this resource shifts the culture of medical education. pic.twitter.com/Coh3RrAVW8
Mind the Gap shows side-by-side depictions of how certain conditions appear on paler skin and darker skin. This is something that has been sorely missing from medical training materials until now.
In an interview with Duncan McCue on CBC Radio, Malone said, "A handbook like this is necessary because at the moment in medical education in the UK, and also around the world, we are often not taught how to identify signs and symptoms in darker skin. So this handbook almost acts as that bridge to fill in that gap in our education at the moment."
He said that the gap in the quality of health care between those with lighter and darker skin became apparent to him long before he entered medical school. "I had heard instances and stories within members of my own community and the Black community about being misdiagnosed or not being taken seriously by health care professionals or just mistreatment, really," he said.
When he got to medical school, it became clear that not only are Black people and other people of color discriminated against because of barely veiled racism but that there was a more institutional level of racism at work too. Doctors simply aren't trained to identify health problems on darker skin.
Big Think reports that Malone worked with Senior Lecturer in Diversity and Medical Education, Margot Turner, and Clinical Lecturer in Clinical Skills, Peter Tamony, to create the handbook. In addition to side-by-side images, Mind the Gap includes "suggestions for appropriate phrases and vernacular" for health care professionals of all kinds to use with their patients.
In conversation with the British Medical Journal, Malone said that when he arrived at medical school, he noticed that students were often taught to look for symptoms, like rashes, in a way that he knew they would not show up on his own skin.
He said, "The booklet addresses many issues that have been further exacerbated during the COVID-19 pandemic, such as families being asked if potential COVID patients are 'pale' or if their lips 'turned blue.' These are not useful descriptors for a Black patient and, as a result, their care is compromised from the first point of contact."
He added, "It is essential we begin to educate others so they are aware of such differences and the power of the clinical language we currently use."
Malone says that making this guidebook available to doctors will "allow some people to live longer, essentially, because they will be able to be diagnosed correctly in the first place." He says it will also help increase trust between patients of color and the health care professionals they encounter.
Mind the Gap is not currently being distributed, but St. George's University is in talks with potential publishers. It's beyond time for something like this handbook to become standard training for doctors and other health care professionals.