by Ohenewaa Nkrumah
On one of my last days at the University of Washington School of Medicine (UW SOM) before I took a leave of absence that was prompted by one racially violent incident after the other, I sat in class fighting back tears of frustration, humiliation, and anger. As a Black queer non-binary student studying in a predominantly white medical school where racism is prevalent, these emotions were familiar guests of mine.
On that day, these emotions had been triggered by a white male child psychiatrist who was standing in front of the class, pointing his index finger in my direction, impatient with my “misbehavior.” Between his berating finger and condescending tone, he authoritatively communicated to me that he did not have the time to engage with my questions surrounding race. We (i.e. he) needed to move on. However, when a white student commented after me that the concerns of students of color should not be dismissed, the professor’s demeanor became more thoughtful and the finger of authority disappeared.
The topic of the hour was Childhood and Adolescent Psychiatry. The child psychiatrist serving as our physician professor of the day was talking about children with Oppositional Defiance Disorder (ODD). According to the assigned chapter of the day, children with ODD were often angry and resentful, often argued with authority figures, and often refused to comply with requests from said authority figures. As the professor tactlessly put it in class, these children were “argumentative, snotty, difficult, challenging, and a pain in the ass.” The medical community was concerned that children with this “disorder” could go on to develop another one called Conduct Disorder, defined as “a pattern of behaviour in which the basic rights of others or major age-appropriate societal norms or rules are violated.”
When I read that chapter and later as I sat in class, I was appalled by the lack of historical context provided about how these “disorders” have been used to justify the oppression of People of Color, queer folks, trans and gender non-conforming individuals, immigrants, and those who are disabled. At the very least, there should have been a discussion about how these diagnoses still contribute to the disproportionate criminalization of Black children and their unfair expulsions from academic institutions.
We were being taught as medical students to pathologize behaviors that are expressed in marginalized communities in response to unfair systems of oppression and yet we did not have the time to talk about how such a practice perpetuates injustices and ill-health. When I named the concerns I had about the erasure of anti-black racism present in the disorders and also in the lecture itself, my attempt to center such a discussion in class was seen instead as disruptive. Like those “argumentative, snotty, difficult, challenging, pain in the ass children” with ODD who passed through this professor’s practice, I needed to be put in my place.
I share this experience not because it is atypical/isolated but because it very much the norm at UW SOM. The pattern of racism is so rampant at this school that students of color struggle to find and retain a basic sense of wellness and safety. Some of us – like me – end up taking a temporary leave of absence. Others have to expand, taking longer to finish. Still others quit the program entirely as the racialized violence builds up and becomes too much to bear.
The hostility we face at UW SOM from faculty, admin, and other students is steeped in history. Historically and to this day, white medical practitioners have been instrumental in the creation and perpetuation of oppressive systems that have justified colonization and enslavement of communities of color. From assigning arbitrary levels of humanity and worth to people based on racialized characteristics (i.e. the Black non-human savage fit to be criminalized and used as property vs. the white human intellectual who is to benefit from the labor of the savages), to creating mental diagnoses that have resulted in the mass institutionalization of communities of color, to constructing eugenics hypotheses and practices that have led to considerable genocide, to enacting rules and metrics that barred people of color from practicing medicine—the brutal history of white western medicine is endless This active maligning continues today and is most evident in the health and health-care disparities we see.
For example, racial discrimination in housing, employment, college education, insurance access, and documentation status result in higher rates of morbidity from cardiovascular disease and diabetes among Black, Native American, and non-white Latinx communities – and these higher rates are further informed by explicit and implicit racism by medical practitioners who interact with patients from these communities. This historical context highly informs an institution like UW SOM that, while coercively built on Native land, is filled to the brim with white administrators, faculty, staff, and students who inject toxic whiteness and superiority into the learning environment.
Since arriving at UW SOM, I have felt the weight of this toxic whiteness keenly. The curriculum from which I am taught often lacks a crucial racial analysis. Diseases and illnesses that are clearly informed by socio-economic factors are taught in a de-contextualized vacuum. In the rare instance that racial justice issues are centered, the teaching is still carried out in a way that is highly aggressive to students of color in the class.
One of my first introductions to the racism inherent in the curriculum taught at UW SOM was from a lecture on the Tuskegee syphilis study. In this research project that spanned 40 years and that focused on African-American men with syphilis, the predominantly white medical practitioners who headed the study intentionally withheld treatment from the men. Instead of focusing on the racialized trauma present in the study and its ramifications on the African-American community, the professor spent most of that class time guiding us through the “ethics” of the study–as if the ethics of a set of actions that so deeply harmed a community was debatable.
As a consequence of this de-contextualization, students were also not given the space to navigate the anti-Black biases we each hold that cause us to harm our patients nor did we focus on how this informs the distrust that black communities have of medical practitioners. I had the displeasure of sitting in this lecture again the next year. Despite critical feedback from the previous year’s students for changes to be made in how this study contextualized racism and accountability in the medical community towards Black patients, these changes were not made.
This trend of de-centering and erasing racism-informed historical trauma from the medical school curriculum repeats over and over. As a Black student, I often feel like I am being taught to kill the very patients I came into medicine to serve. To counter this, I have had to fight every day at UW SOM for the type of medicine I want to practice. Class thus becomes a hostile zone for students of color where biases that the medical field already holds against the communities we come from are reinforced.
As students of color at UW SOM become increasingly aware of the ways racist curriculum pushes us to become physicians who keep contributing to the harm patients of color face, we respond in various ways. Some of us disengage from the school, fragmenting and isolating ourselves so we can pass through the system. Others organize and push back for change.
In my own organizing work in this school, I have come to realize how efficient the school is at swallowing up the labor SOCs expend while giving minimal positive change in return. After student activism efforts last year to call attention to the lack of support for students of color as well as the lack of framing around systems of oppression in the curriculum, the school rolled out a new course called “Ecology of Health and Medicine” with the purpose of addressing social justice issues.
In an amazing example of the school recreating its toxic self, a white physician was appointed to lead this course and it was staffed predominantly with other white leads and facilitators. In my conversations with students of color taking this course, there is still rampant unaddressed macroaggressions. Students of color are thus checking out completely while white students are essentially being mobilized to go out into the physician world to enact their biases.
This is how patients of color end up suffering in medical institutions. Yet in our push for change, students of color are often psychologically punished for our efforts. In a recent interaction with the administration where we were advocating for changes in admission policies that would address some of the racism inherent in the application process, we caused a stir when we took our concerns beyond Carol Teitz, the dean of admissions at the time who was unwilling to treat us as equals and to center our input. Carol Teitz informed us that in breaking rules of hierarchy, we were “unprofessional”, we were at risk of burning bridges, and that we were picking up skills to be problematic physicians to our patients.
Among several other punishment tools, unprofessionality, bridge burning, and the prospects of bad physician-hood are constantly used as a form of control against us by admin and faculty – as if the only way of being “professional” is to meet the colonial and arbitrary white-dominant standards of occupying space; as if the bridges we are supposedly burning were ever even made for us and as if they do not burn us if we succeed on getting on them; and as if good physician-hood is defined by being compliant with a harmful system.
The pressures and consequences of speaking out in this institution are immense and unless we play the game, support for us is truly minimal. The administration and faculty –are more invested in the comfort of white students than they are in the well-being of students of color. Indoctrination into this system, where power is protected and white tradition is maintained, feeds this cycle.
White administration and faculty are invested in and socialized to protect white comfort. Admin and faculty of color, in attempts to navigate a space that is also toxic to them, invariably gate-keep and uphold the status quo. The overall effect is that students of color are not accounted for at UW SOM. We are daily aggressed and dehumanized yet we are expected to bear with it and be silent for the sake of white comfort and professionalism.
Paul Ramsey–current dean of the UW SOM and CEO of UW Medicine–has been a key leader in perpetuating the racism that exists at this institution. In 2016, students of color put out a call to action for the institution to address the racism in its curriculum, admissions policies, faculty development workshops, and student support practices. At the urging of students, Paul agreed to a written and spoken mandate to work with “interested students, faculty, staff, and community members to take active steps to creating an anti-racist medical institution” that “acknowledges the histories and experiences of people of color, teaches about health inequalities and social determinants of health, and enables marginalized folks to thrive at this institution.”
Ramsey’s first steps following that call to action was to implement an anti-racist action committee that ironically excluded key students of color who had first organized this call to action. After “benevolently” giving a charge to the committee to solve the school’s racism issues, he stepped aside for others to do the work. Under this benevolently oppressive leadership, the other deans of this school have then been woefully ineffective.
For example, Leo Morales, the chief diversity officer has minimal relationships with students of color here and lacks the skills to direct anti-racism efforts–meaning even the diversity center in the medical school is not always a safe place for us. Suzanne Allen, the vice dean of academic, rural, and regional affairs still seems to struggle with the concept that students of color are more disadvantaged than white students and that equity requires resources to be divested from the privileged and re-invested in the marginalized.
Anne Eacker and Raye Maestas, the deans of student affairs, despite hearing scores of traumatic stories from students of color, still coddle this institution and yet somehow come back to voyeuristically ask students for more stories and more labor about how to improve the learning environment. Michael Ryan, the dean of curriculum, while being in this position for a few years, has somehow remained ignorant of the concerns students have brought up and embodies to a startling degree the institutional amnesia that this school has around its racist practices. Meanwhile in maintaining silence and seeming passivity, Paul Ramsey acts as warden of a medical industrial complex where, instead of guns, students are armed with biases that kill patients of color, especially those who are Black, trans, queer, Indigenous, immigrants, Muslims, and or disabled.
To break this cycle of silence and harm, I am hosting a sit-in at the Health Sciences Building at the UW SOM. The silence and deflection around the toxic racial climate at this medical school is unacceptable. For an institution that claims as its mission is “to provide service to underserved populations” and to embrace “inclusiveness, equity, and awareness”, it is unacceptable that students of color are suffering here.
It is unacceptable that our histories and our communities are discounted and marginalized despite the countless hours of labor we spend trying to change this. This school wants us for our bodies and not for our minds. We should be celebrated for our core values, for the experiences we bring, and for the communities we uphold.
Instead, we become numbers that fill up diversity quotas. This dehumanization is unacceptable and I ask members of the community who are invested in the health of marginalized populations to join me in holding this school accountable. I ask the city of Seattle and the Washington State legislature to hold this school accountable. I ask the Association of American Medical Colleges, the American Medical Association, and the National Medical Association to hold this school accountable.
I ask the Liaison Committee on Medical Education to hold this school accountable. And finally, I ask those in power at the University of Washington School of Medicine to hold themselves accountable for the pain that students of color endure at this institution. This climate of violence and terror must end.
Featured image DJ Martinez