I am neither Black nor white. I feel awkward and almost out of place commenting on a history in which my relatives did not participate. In my household, I can trace the trauma of the Cultural Revolution on the opposite side of the world more than I can the deep-seated wounds of slavery in the United States. I am used to strangers pulling their eyes into thin slits in mockery, but I know less well of laws and institutions that dictate where I can live and whether I survive. In my predominantly white grade school, our classes ended the discussion of anti-Black racism with the Civil Rights Movement. At the time, my classmates and I expressed indignance that Black children could not attend the same schools as our counterparts prior to the 1950-60s, but we never questioned the absence of Black students in our own school. Only in high school did I begin noticing that the predominantly Black schools in Cleveland had metal detectors where mine did not; these schools were the same ones that the city wanted to defund, citing low standardized test scores.
Now, as a budding healthcare provider in a city reeling from centuries of oppression—most visible recently in the tragic deaths of Ahmaud Arbery, Breonna Taylor, and George Floyd—I find myself learning that while I almost feel out of place writing about anti-Black racism, I am not. Although I may feel more equipped to write about other forms of racism, I am obliged to write specifically about anti-Black racism. I am obliged because I have not had to spend my energy consumed with praying that my loved ones return home alive every day. I am obliged because my family moved here voluntarily without being forced to work in an economy built on their subjugation. And finally, I am obliged because I am assuming responsibility for patients, and I cannot allow my Black patients to continue bearing the brunt of fighting anti-Black racism in America today.
A quick literature search paints a picture that many already know firsthand: African-Americans lose loved ones senselessly at a much earlier age, whether from asthma, cancer caught too late, or violence—too often at the hands of the police. I barely spent any time on the wards before noticing that patients with a history of trauma, poor health literacy, chronic disability, a label of “difficult,” or the words “lost to care” written in their chart are disproportionately Black. COVID-19 has merely reinforced the truth about who bears the brunt of premature morbidity—the poor, incarcerated, and already sick—a population overrepresented by Black Americans.
These tragedies often do not even make it to the news and remain a distant idea for much of non-Black, suburban America. Until clerkship year, I had never comforted someone whose nephew was shot to death or confronted the lived impact of food swamps on the mortality of the human in front of me. As healthcare providers, we are uniquely situated to use our privilege to put faces to the effects of systemic injustice. I can think of few other professions where one encounters persons of such widely varying backgrounds with their scars laid bare, figuratively and literally.
And if we as privileged, non-Black healthcare providers, see these scars but still cannot be compelled to find time or energy to advocate for those who are dying because of their skin color, will any non-Black group ever do so? I see how busy we, our residents, and our attendings are, overworked and burdened with paperwork and administrative tasks that eat away from personal and family time. As a student at the bottom of the totem pole, I often feel small and powerless,
acutely aware of the struggle of individual vs. system. But as medical students, we have each other, and we are the next generation of physicians and healthcare leaders. We are closer to the front lines of caring for Black and other disempowered people than most of America, and this proximity compels us to act.
I recently re-entered the clinical setting, and already, faced with the challenges of becoming the best doctor I can be in a learning environment changed by COVID-19, I catch myself slipping into feelings of helplessness and the mentality that the system is too stubborn to change. But I write to remind myself, as we should remind each other, that if this is how I feel, as an insider now who has made it past costly medical school application fees into a position many never reach, then how much more helpless might our most vulnerable patients feel? Someday, I will climb up the hospital’s totem pole, but the steps up the mountain of systemic racism are not as well-paved. Our feelings of busyness and helplessness are not an excuse to leave anti-Black racism to be a Black issue. We see the physical damage and hear the voices of fellow humans suffering from systemic injustice. For the sake of our patients, our colleagues, and our shared humanity, we should be the ones to listen, learn, and lead in uprooting systemic racism in health care.
Cindy Zhao is a fourth year MD/MBA student at the Perelman School of Medicine. She thanks Dr. Ahmara Ross and Dr. Thomasine Gorry for their support and guidance for this piece.
