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The skin is the largest organ in the body, and it can say a lot about what goes on inside.
This is why doctors pay special attention to how diseases manifest themselves on a patient’s skin.
With COVID-19, for example, doctors have warned families of some patients to watch for blue lips and pale skin – signs the respiratory system may have difficulty delivering oxygen to the body through the bloodstream.
But as Malone Mukwende discovered, these and other symptoms used to diagnose illnesses often don’t apply to people who are not white.
The sophomore medical student at St George’s, University of London, has just created a new guide to help doctors identify clinical signs in black and brown skin. He co-wrote Watch out for the gap with two St. George’s academics, Margot Turner, Senior Lecturer in Diversity and Medical Education, and Peter Tamony, Senior Lecturer in Clinical Skills.
Mukwende spoke to As it happens guest host Duncan McCue. Here is part of that conversation.
Mr. Mukwende, why is a manual like this necessary?
A manual like this is needed because at present in medical education in the UK, and also around the world, we are often not taught to identify the signs and symptoms of darker skin. So this textbook almost acts as a bridge to fill this gap in our education right now.
How big is the knowledge gap between health professionals?
I cannot give a definitive answer as to its size, but [we can look to] some of the health disparities that exist around the world.
We have seen with COVID-19 in the UK, for example, patients who have a [Black, Asian and minority ethnic] history more likely to be affected or more likely to die from COVID. And while there are a multitude of reasons for this, lack of education and lack of knowledge also play a role.
When did it become clear to you that some of your peers, healthcare professionals, had white skin prejudices?
This became evident to me long before medical school, because I had heard of cases and stories from members of my own community and the black community about a misdiagnosis or not to be taken seriously by medical professionals or just bad treatment, really. And I saw the mistrust they had towards health professionals.
When I got to college, to medical school, it almost became obvious to me, on the other side of the fence, that maybe this mistrust and misdiagnosis, maybe it was coming from because people hadn’t learned about it. So they kind of allow those prejudices to come through. And when they qualify and become practicing health practitioners, this is where these biases now take their toll on people.
Example: I have only studied Kawasaki disease with people who have white skin. These are two totally different types of rashes. As a nurse, I would fail my patient. It should be in the textbooks. pic.twitter.com/JvABbonDU6
Can you give us some examples of how an illness or injury can look different on different types of skin colors?
For example, we have seen with COVID-19, the image of Kawasaki disease [a rare and potentially fatal inflammatory disease], which circulated on the Internet. In the photo it is clear that on white skin Kawasaki will appear in very bright red.
However, on dark skin, some people would even say it looks like goosebumps. So these… conditions are the same. But if these two patients showed up to the hospital, we can almost say that if it wasn’t for this knowledge, who would be sent home and who would receive treatment. Therefore, it can mean that someone will eventually die because of it.
I understand that skin cancer can be different for black people as well.
Some people think that black people cannot get skin cancer, and this is because the melanin in our skin forms a barrier, which is true to some extent. However, it is found that skin cancer in blacks is often diagnosed at a terminal stage because people, healthcare professionals and patients in general often miss the first signs simply due to lack of education and lack of awareness. lack of knowledge on this topic.
Why do you think it has taken so long to bring attention to this problem?
The conversation has been going on for many years. If I take credit for saying I’m the first person… it would be doing a disservice to everyone who has spoken about this in the past.
I think the difference is… they put their problem under the rug and people weren’t taking them seriously or giving them the correct airtime. Now, I feel like the world – considering the year we had in 2020 – is somehow receptive and open to recognizing some of the cracks that exist in the system.
And now that people are aware that these issues exist, I think it’s imperative that we start taking action now.
What kind of difference do you think it’s going to make to have this guide available with that information for patients?
Basically I think it will allow some people to live longer, mainly because they can be diagnosed correctly in the first place. And it can also amount to increasing confidence in health professionals, their confidence in health professionals too.
And what kind of a difference do you think it will make for medical students like you?
I think we will now feel more confident in our own practice. So we don’t go out into the world afraid that, “Oh, I don’t know what that looks like in a darker patient and I don’t want to make a mistake.”
So if we are empowered by this, we will be well equipped and be able to better serve the diverse population of people that are in the world.
Written by Brandie Weikle and Morgan Passi. Interview conducted by Morgan Passi. The questions and answers have been edited for length and clarity.