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

Post a Comment

Popular posts from this blog

PTSD - A Psychodynamic Explanation

Post-traumatic stress disorder (PTSD) is a type of anxiety disorder which you may develop after being involved in, or witnessing, traumatic events. The condition was first recognised in war veterans and has been known by a variety of names, such as 'shell shock'. PTSD can develop immediately after someone experiences a disturbing event, or it can occur weeks, months or even years later. Its estimated to affect about 1 in every 3 people who have a traumatic experience, but it's not clear exactly why some people develop the condition and others do not. There are many theories that could be used to explain this condition. Psychodynamic approaches to PTSD focus on a number of different factors that may influence or cause PTSD symptoms, such as early childhood experiences, current relationships and the things people do to protect themselves from upsetting thoughts and feelings that are the result of experiencing a traumatic event. The psychodynamic approach focuses mainly...
Read more

Disparities in Global Eye Care

Vision is one of our most precious possessions. Multiple polls globally show that most people are more fearful of becoming blind than losing any other sense. (1,2) With sight being such a valuable asset, one would assume that eyecare is at the forefront of medical services across the world. Living in the developed world, we perhaps take for granted the simple and yet crucial services available to us such as regular eye tests, glasses, contact lenses and high-quality ophthalmic care - most of which can be accessed for free or at a subsidised price. However, in many parts of the world this is not the case. 285 million people worldwide are visually impaired, with 90% being from developing countries. (3) In China, for example, levels of blindness are increasing each year, however critically, rates of blindness have been reported at up to 4 times higher in the developing world as compared to more economically developed countries (4, 5). This is particularly worrying given that around 80% of...
Read more

Do Contact Lenses Really “Support Your Vision”?

Image
Contact lenses have been frequently used as an alternative to glasses. Compared to the heavy-framed glasses in front of one’s eyes (optic glasses), thin plastic discs on the eye (contact lenses) help correct refractive errors in both myopic and hypermetropic users. The lens’ shape and power can be tailored to the user’s sight. A concave lens can be used to decrease myopia by reducing light refraction and increasing focal length so that the image is formed on the retina (1)  (Figure 1). Alternatively, a convex lens can be used to limit hypermetropia in an opposing mechanism to concave lenses (1) (Figure 1). Figure 1, An illustration of myopia and hyperopia and how adding lens of different shapes in front of the eye can be used to alter the refraction of light and correct each impairment in vision (10) Besides supporting sight, which both types of lenses can do, contact lenses confer some advantages that make them preferable to glasses. Unlike glasses, contact lenses are less li...
Read more