(Image: Cover of “Mind the Gap: A Handbook of Clinical Signs in Black and Brown Skin”)
Medical students should be trained to correctly diagnose the symptoms of common conditions and diseases, then deliver the appropriate care.
Sounds straightforward, right?
Not for Malone Mukwende, who didn’t find examples of dark skin in his textbooks and classes at St. George’s, University of London.
“But what will it look like on darker skin?”
The second year student failed to see depictions of conditions on darker skin tones, and knowing that common physical reactions present differently on his own skin, he knew it would be an issue for patients of a similar skin tone. This gap in medical student training can lead to misdiagnosis and mistreatment, with possibly fatal consequences.
So Malone worked with staff members of his school to create “Mind the Gap,” a handbook for how clinical conditions appear on dark skin. He applied for a student-staff grant which was approved in December 2019.
Some of the conditions included in the handbook are skin cancer, meningitis, jaundice, eczema, psoriasis, and others. One example is Kawasaki disease, which presents as a conspicuous red rash on white skin, but is much less noticeable on dark skin tones.
One issue they’ve encountered is finding images of certain conditions. This is such a pervasive issue that they’ve been approached by the British Association of Dermatologists and NHS (National Health Service), who have also had trouble obtaining pictures.
According to Patricia Louie, an incoming assistant professor at the University of Washington, medical textbooks reflect this issue as well. She found that nearly 75 percent of images in commonly used medical literature are of light skin tones, while fewer than 5 percent are of dark skin tones.
As an example, her research found that medical textbooks in South Africa, with a predominantly black population, mostly feature white bodies and light skin tones.
Producing textbooks with more diverse imagery isn’t the silver bullet, “it is pertinent that doctors understand the role that structural racism plays in producing these disparities in the first place.”
The Big Picture
The unfortunate reality is that medicine is plagued by disparities in outcomes due to biases that exist in our medical professionals and the system at large.
Biases can arise in education, training, or result from cultural influences. The causes can be hard to pin down in some cases. But regardless, the result shows up in the data.
For example, mortality rates for black newborns increase significantly when delivered by black physicians compared to white physicians. This is closely connected to adverse maternal health outcomes in the U.S., which is partially attributed to structural racism as a significant risk factor for African-American mothers.
Additionally, multiple analyses of federal, state, and local data show that people of color are experiencing a disproportionate burden of COVID-19 cases and deaths. These disparities are especially large for Black and American Indian and Alaskan Native (AIAN) people.
There’s still so much to be done in reducing the health disparities present in high-risk populations. See the links below for additional reading and comment.
“A Medical Student Couldn’t Find How Symptoms Look on Darker Skin. He Decided to Publish a Book About it.” Washington Post. July 22 2020.
“Representations of race and skin tone in medical textbook imagery.” Patricia Louie. Feb 23 2018.
“Health System Tracker.” Rabah Kamal, Peterson-KFF. October 18 2019.