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The white elephant in the room

Dr Shaba Nabi

dr shaba nabi duo 1440x960px

dr shaba nabi duo 1440x960px

One of my earliest memories is from the age of six, when my infant school put on a production of Snow White. Despite being the best reader, I already knew at that tender age I was not in the running for the lead role because I was not white. Instead, in keeping with Hollywood tradition where the black guy is the villain, I was cast as the wicked stepmother.

Such truisms continued into secondary school, where I knew I would always be the last to be picked for team games. It wasn’t until I became the captain of every sports team in the school that I was finally accepted.

It was a miracle I landed a place in medical school, when it was exposed that St George’s had a points system that downgraded women and anyone with an ethnic-sounding name.1 Considering this medical school was one of the most multicultural in London, I shudder to think of processes elsewhere. In fact, my older brother was kicked out of Barts for failing his first-year exams a month after the death of our father. Unlike several other students who were allowed to stay after failing their exams twice, my brother was not a white, ex-public-school boy who played rugger.

A memorable moment for me as a medical student was the time I was sent to Cambridgeshire to achieve my quota of deliveries. I thought my luck was in when a woman was admitted to the labour ward already 9cm dilated. But the kind midwife quickly ushered me away saying: ‘This one’s not for you, pet.’ Then I spotted, written in red ink all over the woman’s notes, ‘No Pakis anywhere near me’. The irony was that she ended up having an instrumental delivery in theatre attended by an African obstetrician, an Asian anaesthetist, a Chinese paediatrician – and me holding her hand.

I would love to look back on those bad old days and say things are different in 2018

But racism within general practice is far more covert. GP partnerships see themselves as a family or a marriage – one that must not result in an acrimonious divorce. Normal HR rules do not apply as it is vital to find the ‘right fit’ for the practice. This means finding someone who looks like you, dresses like you and speaks like you. A love of Kiss FM over a fondness for Radio 4 was definitely not the right fit for the leafy suburbs.

So, despite holding membership of two royal colleges (with distinction) and having leadership experience outside the NHS, I faced rejection after rejection. But I was fortunate enough to take the old MRCGP exam and not endure the CSA challenges faced by our current BME trainees. Obviously, good communication skills are essential in our profession, but performing role play with an actor may not be the best tool to calibrate this in a certain cohort of doctors.

I would love to look back on those bad old days and say things are different in 2018. But as my daughter is getting ready to perform in Beauty and the Beast at the Bristol Hippodrome this summer, I have already warned her that despite being a talented actress, she is unlikely to be cast in the role of Belle because she is too young.

But sadly, I know her age is not the only reason.

Reference

1 Commission for Racial Equality, 1988. Medical school admissions. Report of a formal investigation into St George’s Hospital Medical School

Dr Shaba Nabi is a GP trainer in Bristol

 

 

 

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Readers' comments (40)

  • Bob Hodges

    I'm shocked about the St George's thing Shaba

    In my partnership of 14, we have the following origins:

    Malaysia
    Germany
    India x 2
    Bangladesh
    Pakistan
    Gibraltar
    UK x 7

    I don't feel that we're unusual in our area in this regards, and it feels completely normal. Perhaps that's the direction of travel, because it should feel normal.

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  • I find I am in a much smaller minority as white male from a working class state school with a dodgy northern accent.

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  • Ditto above.
    Another angle to pursue for the permanently offended.

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  • Excellent Shaba, as a Jew whenever I never had the chance at something I beat myself up that it was me .Now at the grand old age of 50 i realise its my name and background.I lost extra confidence despite have excellent attributes like you and being musically talented on top.Even my daughter who led NYO last year was not given the advertisement previous leaders had because she was BME so they hid her leadership place under the carpet.She didnt get the radio interviews etc attributed to such a top position.
    I went for a few interviews recently and walked into one practice that was pure white I have to say, I knew from that moment I was out of the running.

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  • Vinci Ho

    We , human beings, always succumb to the temptation of judging the book by the cover , by the label.
    The biggest ‘label’ is obviously your skin colour . But so often , it is more than that ; men against women , north against south , one religion against another , rich against poor , heterosexuals against homosexuals (for us, even specialists against generalists!) etc . The list is an exhaustive one.
    Fundamentally , if I don’t ‘like’ you , anything you do or say is vile and you deserve my automatic rejection. If you do not belong to my ‘group’ or tribe, you need to stay away .Thousand years of history have passed and we do not seem to have learnt any lesson .
    But then we also talk about ‘freedom’ ; freedom of speech , freedom of expression and freedom of press . Question is ‘does everyone know the true meaning of freedom?’ Indulging in the reflex actions following our likes and dislikes , is not to me freedom. This indulgence with hasty judgement (instead of discerning the facts of the matter ) is , ironically, our invisible shackles .Rather, I would want to ask myself everyday whether I have treated others fairly and respectably . Ultimately, it is also about our capacity to accommodate, really great capacity we are talking here. The same capacity when Voltaire wrote ,
    ‘’I disapprove of what you say, but I will defend to the death your right to say.’’

    Unfortunately, the recognition of this ‘universal virtue’ is often blinded and overshadowed by our greed , self-pride and most significantly , desire to overpower those we would consider as inferior(pure malice if being conscious; biased if being unconscious!)
    Those who share these ‘qualities’ are members of our tribes ; those who don’t are aliens. Zuo zhuan (左傳), one of the oldest Chinese historical literature written over 2000 years ago , already had this saying ,’ if you are not in my tribe , your heart must be different’ (非我族類,其心必異).
    This world remains as conservative as once it was . Instead of progressing with our civilisation, we have chosen to regress to tribalism , isolationism and protectionism. We deliberately allow our differences and disputes to ferment into prejudice and discrimination. With some spices of arrogance and bigotry, we direct hurtful actions (inactions) against each other .........

    "No-one is born hating another person because of the colour of his skin or his background or his religion."
    Nelson Mandela

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  • The comments to this article has highlighted part of the problem.
    We as GPs do need to do better. We need to keep ourselves to a higher standard of informed conversation. We need to keep the discourse considered, caring, reflective and solutions orientated to support colleagues when there is an obvious multi level evidenced problem.
    @Bob - the sentiment is very well put. The direction of travel is encouraging but we have a long road to travel and we all should continue helping the arc of human civilisation improve. The only thing shocking about the St. Georges case is that they were stupid enough to formalise it and leave an audit trail. As you allude to and looking at the stats they were not the worst offenders, just the dumbest. South Africa was equally dumb by keeping laws on the books to engineer prejudice that could be easily attacked by other more 'civilised' countries. Multiple other countries eg.USA, etc etc had worse stats but are able to project a better 'brand' of supposed inclusion. Your practice seems a wonderful place/example.
    @watchdoc - please don't take this the wrong way but helping one marginalised community does not exclude helping others. Its not zero sum. In fact social science evidence suggests that caring for other human beings has positive effects on the whole of society. A rising tide... The tribalism reasoning does not travel well. A BME woman from a working class state school with a dodgy northern accent will do much much worse than you did. Our success in life as GPs, is always a combination of our stunning genetic brilliance which is outweighed by an order of magnitude by environmental factors.
    @Harvey Steinwein - not sure how to advance the conversation/respond. Probably disappointment? Again smart caring people should try to help. Again please don't take this the wrong way but 'taking offence easily' is not what Carolyn Wickware's report in this edition of Pulse, points to. I am hoping that having considered the Dr Bawa case and read the references in Carolyn Wickware's report that you could change your heart (just a little) about the gravity and reality of the problem. I do hope
    @Another Titled Buffon - ..... Odd that Shaba's personal heartfelt and vulnerable article generates a twitter-esque #AllLivesMatter response. I feel disappointed and wonder if Shaba feels even worse, probably even hurt. Carolyn Wickware's piece was presented as hard evidence and I suspect the editor thought that the balance with a more personal piece would help smart, caring, empathic professionals understand the true impact of institutional as well as personal racism. So as not to fuel a tit for tat I don't think it would be helpful for us to challenge the extrapolation of hiring "close family members" reasoning. Adding this to a debate of preferentially hiring, promoting, passing, advancing not prosecuting or imprisoning doctors/people(strangers) other doctors of your own race?.. Following the family/race logic seems to travel down a worrying rabbit hole that I am sure you did not intend.
    @Vinci Ho - could not have put it better myself! Beautifully researched and written.

    We should recognise that all human beings have inherent biases. We improve as people and as a society when we acknowledge them and always humbly try to improve ourselves and help others. We may be relatively powerless to change patients and the public. That should be no reason to avoid change in ourselves and our sphere of influence. We should worry about trumpesque/school debate tactics eg. exaggerating the position of your opponents point of view and worse still exaggerated and falsely attributed solutions ("increasing punishments to non-BME so as to be seen to balance the books." watchdoc). We should not absolve ourselves from the real world change we can make to our own point of view. We can and should influence our immediate working environment and our leadership where we can. We are educated and lettered professionals and should hold ourselves and our profession to a higher standard.. We all have daughters, friends, colleagues and a wider society that will benefit.

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  • Works both ways. White males now discriminated against in interviews.

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  • Evidence?

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  • @just a gp
    Sorry for snappy response. Just trying to start an evidenced solution based conversation to an obvious problem. Just get exasperated when the commentary from fellow well qualified GPs, seems just as tribal, emotive and pointless as trump/twitter. Was hoping to have my faith in humanity's ability to cite evidence, to reason, to solve problems and to care for other human beings restored on this platform...

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