Bader Alamri is a PGY5 resident in Endocrinology and a PhD student in experimental medicine, in the Department of Medicine at McGill University in Montreal.
As an international medical graduate (IMG), I encounter both hidden and overt racism in my day-to-day work. I have realized that it has become a skill – rather than a struggle – to respond to racist and bigoted comments by proving myself as a competent doctor. But what I am about to share with you is not the “usual” comments.
The incident I’m about to describe happened in March 2020. You may ask why, after more than six months, I am choosing to talk about it now. The answer is: Joyce Echaquan, a mother of seven, who was insulted by a hospital staff member while being admitted into the hospital days before her death.
In March 2020, before the Quarantine Act was in effect, my wife and six-month old daughter returned to Canada after a short vacation abroad. Because I had busy days in the hospital that month, I could not join them on the trip. A week after their arrival, my little one developed a cough, had difficulty breathing, and was unable to feed. Our concern was COVID-19. The public health service advised us to take our daughter to the children’s hospital. That day, I was the senior trainee covering the consult service in the medical complex’s adult side. I met up with my wife and daughter in the pediatric emergency department. I asked them to wait for me until I had called occupational health to check if I needed to isolate myself. Occupational health personnel advised me I didn’t need to self-isolate pre-emptively as my daughter’s symptoms were common, but that I should isolate if COVID-19 was confirmed.
I went back to see my daughter, who had been put in a monitor bed with IV fluid. I was wearing my hospital ID badge because I was working that day. The ED staff got the history from my wife, and then turned to me and started asking about my travel history. I confirmed that only my wife and daughter had returned from abroad to Canada as I am a resident doctor and did not have the chance to join them. Ten minutes later, another pediatric ED staff member called my cell phone. Instead of asking more questions about my daughter, he questioned me again about my travel history and if I had visited my country of origin. I repeated my answer.
My daughter needed to be admitted for hydration and oxygen and, while we waited for the admission, I had to go back to work as no other senior was available to cover for my absence.
That day, I received two additional phone calls from my academic staff asking about my vacation history. In the second call, I insisted on knowing why I was being asked those questions. The caller admitted that there was a request from the children’s hospital inquiring about my integrity as a doctor and my vacations in the previous two weeks. I explained that my daughter had been admitted, and I did not understand why they had gone behind my back to inquire about something I had just confirmed to them, not once but twice.
Some racialized minority groups are wary of medical care and I have often wondered why. Is it because of their culture of prioritizing traditional healing? Or is it because we – the health professionals – cannot deliver the care they need? I’ve never considered whether it was because they do not want to be insulted. But insults from health care staff were clearly evident in Echaquan’s story.
My daughter did not have COVID-19. During her admission I asked my wife to hide that I was a doctor working in the same complex, to avoid having to endure repeated insulting suggestions that I was lying about my travel history. I kept asking myself if they were treating my daughter based on her father’s origin, and wondering if she would get less care because her mother has a different skin color. These questions may seem silly to you. To me, as a father, they seemed perfectly reasonable.
In fact, the nurses and medical staff were amazing. One of the nurses recognized me and said good things about the time I had worked with her on the same floor. Her comments offered some consolation after the insults I received in front of my wife, from the same system I am working in.
The story of racism in the medical field is long and complicated, especially in a multicultural environment, and the medical literature is rich in studies looking at racism towards patients in the health care system and also racism as a determinant of health. Yet the implications of those studies are barely discussed. I don’t think the situation will improve only by changes in medical school curriculum or policy at hospitals. Before we see real change in the doctors’ offices, it will have to come from the people, communities, religious gatherings, and many other places.
Malcolm M MacFarlane
I was saddened to read of Dr Alamri’s experiences of hidden and overt racism as an IMG, but I also admire his courage in raising these issues of systemic racism publically. This type of dialogue is crucial to recognizing and eliminating both conscious and unconscious racial bias in the medical community.
While the medical system may be rich in studies examining racism toward patients in the health care system and racism as a determinant of health, studies of racism and discrimination experienced by IMGs in published medical literature are sparse. Does this reflect a reluctance on the part of the medical establishment to examine these issues in a critical manner?
For those interested in exploring IMGs experiences of discrimination and marginalization, the following unpublished dissertations and theses are worth reading:
Many thanks to Dr Alamri for raising these important issues.
This is a sad reality of our health care system. Thank you for sharing your story. We need to speak up for ourselves and continue to challenge racisms and discrimination for greater benefit. I know this is not a easy task, but I feel it has to be done at least for our future generation.