The Importance of BAME representation in Medical Education

Akhil Hanmantgad


[1] [2] According to a census taken in 2011, it was estimated that Black, Asian and other Minor Ethnicities (BAME) accounted for roughly 14.5% of the UK’s population, which at the time would equate to around just over 9 million people. Since then, the UK’s BAME population has grown, whilst our understanding of their medical needs has not. 

[1] During the COVID-19 pandemic alone, it was found that Persons of Colour (POC) were 1.5 - 2 times more likely to die compared to their white counterparts. Epidemiologists attribute this difference to social inequalities such as predisposed health issues, crowded living situations and occupation. Whilst the above factors would contribute to an increased incidence of COVID-19 amongst BAME communities, it does not explain why POC were at a much greater risk of dying from the virus in the UK compared to their countries of origin. [3] [4] For example, in India, the number of cases have overtaken the UK, however, their death rate lower at the time of writing this article.


Assuming that Indians living in India are genetically predisposed to the same health conditions as Indians living in the UK, as well as the fact that the social and economic inequalities present in India mean that there are many communities living in poverty and in far more cramped living conditions, how is it possible that there is such a difference between the death rates of POC in the UK and their country of origin? Could this mean that there are certain signs and symptoms of COVID-19 which present differently in POC, which have either not been understood or been overlooked by medical professionals? If so, the COVID-19 pandemic is not the only example in which this seems to be the case. 


During my time at medical school so far, I have personally come across many conditions which could present differently in POC, compared to their Caucasian counterparts. The modules we studied in my second year alone ranged from infections such as meningitis to problems affecting the liver and endocrine organs. In each of the aforementioned topics, we learnt about examples of conditions which are characterised by dermatological signs which have major diagnostic value. In the case of suspected meningitis, we were told to look out for an ‘Erythematous Rash’. In the case of liver damage, we were told to look for a ‘yellow colouration of the skin’ (called jaundice). And in the case of Addison’s Disease (a disorder of the adrenal glands), we were told to look out for a darkened skin tone (called hyperpigmentation).


To help with our understanding of the above descriptions, we were provided with visual aids, such as images, to help us picture these presentations more easily. These pictures were usually of a Caucasian ‘model’ patient, whose abnormal presentations could be seen clearly against their lighter skin colour. 


However, being a person of colour myself, I had often wondered whether these presentations would look different on a person with a darker skin tone, and if so, whether that affected their diagnosis and treatment. Through my own research, I was able to ascertain that skin colour was possibly a contributing factor in the diagnosis and incidence of Addison’s Disease and Liver Cirrhosis. 


[5]Regarding Addison’s Disease, I learnt that most symptoms of this adrenal insufficiency are non-specific. A defining sign of Addison’s Disease is the hyperpigmentation of the skin, which can present months, or even years before the onset of other symptoms. However, this presentation can be absent in some patients. Due to the increased number of melanocytes in the skin of POC, compared to Caucasians, it is possible that hyperpigmentation in patients of colour presents much more subtly compared to Caucasian patients. This could lead to a delay in diagnosis, which in turn could result in poorer outcomes for POC with Addison’s disease. 


[6]Regarding Liver Cirrhosis, the Medical Council on Alcohol released a study which proved that East Asians and South Asians were up to a 50% greater risk of developing liver cirrhosis, compared to Caucasians and people of African origin. Again, it is possible that jaundice is a lot more subtle in Asians, due to the similarities of this presentation compared to their natural skin tone, and is therefore not picked up as quickly by medical professionals. This could affect their treatment and prognosis, as their diagnosis is delayed whilst medical professionals rely on other signs and symptoms to present themselves.


[1]In conclusion, it is clear that our lack of understanding about the medical needs of POC puts roughly 15% of our population at risk. It is therefore important for medical schools to incorporate aspects of BAME medical education in every module that they teach and address this gap in our knowledge. It is also important for current practicing medics to keep up to date on this knowledge as well. As current and future medical professionals, we have taken an oath to help all patients to the best of our abilities. So let us begin by improving the lives of our BAME community, one step at a time.


References

[1] https://www.bbc.co.uk/news/uk-52219070

[2]https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/bulletins/2011censuspopulationestimatesfortheunitedkingdom/2012-12-17

[3] https://www.worldometers.info/coronavirus/country/india/

[4] https://www.worldometers.info/coronavirus/country/uk/

[5]https://rarediseases.org/rare-diseases/addisons-disease/

[6]https://academic.oup.com/alcalc/article/51/5/593/1739915

Comments

  1. Aaron11 August 2020 at 21:22

    A very well-written and informative article - it is great to see medics such as yourself and Malone Mukwende bring light to this crucial topic.

    ReplyDelete

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