Without a doubt, the past year has been a challenging one, and will go down in history. It has been a difficult time for people of all walks of life and many of us have struggled mentally. For those of you applying to university this cycle, you are facing a level of uncertainty that previous generations have not had to deal with. Once again, exams have been cancelled and the way in which A Levels will be graded has changed. The details for the way in which you will be graded are not yet clear and it would be completely normal to feel overwhelmed by the ongoing disruption to your education and future plans. However you may be feeling at the moment, these turbulent times remind us of two important characteristics that doctors must have - resilience and being prepared. Developing these skills will aid you when it comes to results day and beyond, whatever the outcome you face. So what is resilience? I like to think of it as our ability to adapt and respond to stressful situations. In other words, it is our ability to bounce back when things get tough. On the whole, medicine is a fantastic career but there will be testing times and occasions where you encounter difficulties. Resilience training is something that you may or may not encounter at school, medical school, or as a doctor. However there are some good resources online that delve a bit deeper into how to develop resilience and provide exercises to try. These include the Stanford School of Medicine WellMD site, amongst others. Whilst learning more about resilience is important, we mustn't forget the basics when it comes to looking after our own mental health and wellbeing. Black communities face a lot of additional challenges when it comes to mental health. For example, we know that the risk of psychosis in black Caribbean groups is seven times higher than in their white counterparts. This highlights how essential it is that we look after ourselves, especially at times of significant stress. Key practices that can help with our wellbeing include mindfulness, exercise and having a good support network. The Melanin Medics blog team have a number of articles on these topics that I would highly recommend. For example, the article on our Mind Us project, which can be found here goes into some detail about how you can nurture your wellbeing. We have another article here that discusses the importance of exercise for your wellbeing, and a further article here on mindfulness. These are just a few examples of what we have in our blog archives so make sure to take a look! Now, moving on to the art of being prepared. As doctors, being prepared for all eventualities is a key skill, as you never know which emergencies or other challenges may arise on any given day. As aspiring medics in the middle of a pandemic, being prepared is going to be especially important for you too. We have a great article in our archive here about what to do if things don’t go your way. Amongst other areas, it includes information about UCAS Clearing, taking a gap year and alternative routes into medicine. We will also be posting further articles on some of these areas as the year goes on. To summarise, all the chaos in the world has made it a tough time to be an aspiring medic. Being prepared for any outcome of your application and having the resilience to deal with any hurdles that arise will set you in good stead for the rest of your career. Whatever happens, the Melanin Medics team will be here to support you throughout. From applying to medical school all the way through to your careers as doctors, we’ve got you. Dr Katy Chisenga 1. Fearon P., Kirkbride J.B., Morgan C. et al. (2006) Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine, 36(11), 1541-1550

Monday Monday – here’s hoping to a great start to the week! After grabbing my trusty golden syrup porridge and a strong cup of coffee I’m ready for the day. Today I have a full day of online learning (thanks, COVID) via MS Teams and on the university specific platform. I’m currently on my secondary care placement (oncology and palliative care) at the moment, so a lot of my private study is based around the 4 commonest types of cancer (Breast, prostate, lung and gastrointestinal) as well as the common treatment regimens and side-effects that are associated with those. Today our online learning was more based around communication skills and how to break bad news sensitively. During the teaching, the doctor/honorary lecturer said something that really resonated with me today – “sometimes the worst bad news is often when people leave your room not knowing that they have been given bad news”. This really made me think of how to achieve the right tone when delivering bad news, as I’m definitely someone who likes to sugar coat things, but in a lot of situations within Medicine, it’s just imperative to be as empathetic – but also as honest as possible. In between my online learning I also organised my 2020/2021 tenancy today with my flatmates. We’re staying in the same flat as we live in now – yay! We’re all relieved as an unnecessary move would definitely not have been welcomed (I have a LOT of clothes). I texted my mum to tell her the news – she told me not to worry about it and she was right (as always!) Tuesday Today I was scheduled to be in a radiotherapy review clinic, but when I arrived it had been cancelled (boo!) Although every cloud has a silver lining – it was nice(ish) weather today so I managed to have a lovely walk and enjoy some fresh air. I even managed to chat with an old friend on my way home when I seen her getting off the same bus. After arriving back home from my failed attempt at placement, I completed some revision on long-term conditions (e.g. Diabetes, hypertension, COPD) and looked through some videos of clinical examinations to refresh my memory. My oncology/palliative care placement also has a primary care element attached to it whereby I am required to learn essential long-term management of some chronic conditions like those mentioned above. I intercalated after 3rd year so it always feels like a LONG time since I have done a lot of things Medicine related, although slowly but surely I’m getting there! After getting through some work, I chatted to my Dad and worked my way through my Christmas chocolate collection (my favourite part of the day!). Wednesday Today I have a virtual ward round. Cool right?! It works like this – the doctor wears Virtual Reality (VR) goggles, medical students are signed in on a MS Teams call. When the doctor is seeing a patient on the ward round, we take a ‘history’ from the patient – typing in any questions we have into the chat function on MS Teams. The doctor then sees these questions and asks the patient directly, and when the patient responds we can see/hear them through the VR goggles. I think it’s very admirable how many clever people have envisioned innovative ways to ensure medical education remains as high quality as possible through this pandemic. After the VR ward round and teaching, I relaxed and listened to some music for a little while and continued binge watching How To Get Away With Murder on Netflix (SO good, would definitely recommend!) Towards the end of the afternoon, I also began preparing for my shift at work. I’m able to work from home (yay) as I’m a judge/chairperson for regional debating competitions in the UK. I work for the English-Speaking Union (ESU) and take shifts on an ad-hoc basis to fit around Medicine. Today the whole debating competition was on zoom, so it was interesting to be the judge for this, as previously all of the competitions I had judged have been in person. However, it worked well, and all of the children involved gave excellent speeches. Thursday Today I successfully managed to get some in-person placement time! This morning I was paired with a lovely consultant in the outpatient urology clinic. This clinic is for people who have been diagnosed with mostly kidney and bladder cancers. Although it was a telephone clinic, the consultant kindly gave me my own room and allowed me to have a telephone consultation with one of her patients after she had already talked to him. This patient was so kind and interesting. He told me about his journey from diagnosis until now, and how his kidney cancer diagnosed had affected some aspects of his life, but other aspects remained the same. He was very optimistic and cheerful, which allowed me to reflect upon the mental ramifications a cancer diagnosis may have on thousands of patients, but which protective factors will allow them to still maintain a good quality of life – a life that is worth living from their own perspective. Despite my great morning, the afternoon did not end so well. It all began with a snowy disaster. It had been snowing lightly in Leeds when I had left home on the morning, so I had (smartly) decided to put my wellies on. When I left the urology clinic, I was greeted with deep snow. The hospital shuttle buses had been stopped, public buses had also been stopped and all local taxis were quoting at least a 2hr wait due to the snow. As all annoying/bad things seem to happen in sequence, my phone died as I was waiting for the taxi. On the bright side, I met a lovely nurse while I was waiting in the hospital, and as we were chatting, she made the time pass by a lot quicker! Fast forward 4hrs later, and I was finally home (with VERY cold feet). The Christmas chocolate supply was definitely needed this day. Friday FRI(YAY!) Today I was only timetabled for a 1hr online learning session via MS Teams. This session was very useful, as a consultant oncologist went through a series of case studies based on oncological emergencies and what to do in these situations. I learnt about metastatic cord compression, superior vena cava obstruction and neutropenic sepsis. It did not surprise me the immediate management plan for metastatic cord compression was to give 16mg dexamethasone and adequate gastric protection, if in doubt in an MCQ I always choose dexamethasone!! Dexamethasone seems to me like a potato, it is a multi-functional QUEEN! My Friday ended with a bit of relaxation, more binge watching How To Get Away With Murder, and video calling my lovely boyfriend to complain about my chocolate addiction (he is a saint for listening!) I’m definitely looking forward to a few days off, although I’m on-call on Sunday so hopefully I can get more patient contact and hands-on experience. Fingers crossed! Written By 4th Year Medical Student (Anonymous), University of Leeds References Cover Image: https://www.healio.com/news/primary-care/20201013/recent-events-spotlight-need-for-more-black-female-physicians-speaker-says

The Mind Us Project The Mind us Project is a 12-month development programme for Black African and Caribbean final year medical students, which focuses on educational advancement and wellbeing support. Final year medical students enrolled onto this programme will receive mentorship, medical education, and virtual learning sessions. We wanted to develop a project that focused on nurturing student educational enhancement as well as resilience and wellbeing, in order to make the transition from medical school to being a junior doctor as smooth as possible. This Nurture Your Wellbeing blog series will run in tandem with the Mind Us Project, providing a safe space for us all to reflect on the importance of our mental wellbeing through these unsettling times. It is our hope that we can all gain strength, resilience, and the knowledge of how to nurture our well-being through innovative projects like Mind Us, and the power of reflection. The Power of Reflection: Why is the Mind Us Project so Vital? 2020. It has been a tumultuous year encapsulated by that virus, the re-awakening of the BLM movement and social activists aiming to tackle the systemic racism encroached in our society. We have all been given the opportunity to reflect on what truly matters to us – and how to protect the things that mean the most to us. A recent Melanin Medics survey exploring the wellbeing of 152 Black African and Caribbean medical students revealed 89% of respondents felt COVID-19 had impacted their wellbeing, with 60% expressing concerns that COVID-19 would affect their career progression.(1) With further worrying evidence of a wide disparity in deaths from COVID-19 amongst BAME people compared to their white counterparts, the Royal College of Psychiatrists (RCPsych) created a series of immediate steps that can be implemented as risk mitigation for BAME staff – identifying health and wellbeing support as a priority (See Figure 1).(2) Figure 1: Risk Mitigation for BAME Staff. This multifaceted plan created by the Royal College of Psychiatry identifies health and wellbeing support as a priority for risk mitigation.(2) With this in mind, we direct this question to all Black and Caribbean prospective medical students, current medical students, and current workforce, and challenge you to consider: What does mental wellbeing mean to YOU? Take 60 seconds to reflect on what the word ‘wellbeing’ means to why and why it resonates with you. Is it reconnecting with an old friend? Talking to family members? Getting your 60 minutes of exercise every day? Now ask yourself, why did you decide to study Medicine? For a love of humanity and patient care I hear you say? Remind yourself, a love of humanity also requires you to love and look after yourself, as well as others. What is Wellbeing? Mental wellbeing is defined as “The state of being comfortable, healthy or happy” relating to both physical, emotional, financial, social, occupational, spiritual, intellectual, and environmental wellbeing.(3) Some research has also found the role of race plays a fundamental part of an individual’s perception of themselves and how racial identity and psychological distress are categorically linked, especially with respect to high-achieving young adults such as medical students and doctors.(4) All of this sounds like a lot to be having under control, right? Well, we would like to help you in your pursuit of mental wellbeing. How to Nurture Your Wellbeing: Advice and Tips 1. Connect with others. As a busy medical student or doctor who is constantly working, it may be difficult to find the time to connect with your loved ones, but good relationships are so vital to our mental wellbeing. Remember, you are your most valued investment so always take the time to connect with those close to you. 2. Be physically active. Exercise helps to improve overall mood and cognition, if done regularly. FUN FACT: Exercise also increases the serotonin levels and brain-derived neurotrophic factor (BNP) levels in the brain which help to regulate your mood. 3. Practice Mindfulness. Is your phone always pinging with notifications either from work, university, or social media? Are you constantly checking your emails, creating revision quizzes on quizlet, or completing practice exam Q’s on PassMed? If the answer is yes, take the time to engage in mindful activities to help you become astutely aware of your thoughts, feelings, and body sensations. Check out Headspace, an app for meditation and mindfulness. 4. Give to Others. Helping others, talking, and relating to others allows us to feel supported and connected within our own lives. Remember, as well as looking after our own mental wellbeing, it is vital to protect the wellbeing of others. 5. Learn New Skills. We all remain dedicated to our current and future patients and this inspires us all to continue studying. But remember, we all need a life outside of Medicine. Are there hobbies you used to enjoy that you no longer do? Try practicing these skills, old and new. You might just find they’re good for the soul. Remember, achieving mental wellbeing is a lifelong pursuit. We may all find ourselves struggling from time to time and it’s important to be self-aware and recognise when you’re struggling. Helpful Toolkit: - What to Do When You’re Struggling - Talk to a friend, partner, family member. Sometimes, it’s difficult to find the words when you’re struggling, therefore journaling, or keeping a diary can be helpful. Remember you’re not alone and there’s always someone who cares about you who wants to help! -Reflect: why are you feeling like you do? Has there been a stressful event? Have you been overworking, or are you experiencing burnout? As medics who lead very busy lives, we often overlook the importance of eating enough, maintaining a regular sleep pattern and scheduling time for relaxation. Try to schedule time to relax, just like you would for study/work time. -Struggling and feeling like it’s affecting your work/study life? Talk to your GP. They may be able to help, sometimes simple chat with someone who isn’t an immediate family member/friend can provide perspective on a situation. -There are a range of accredited psychological therapies available on the NHS. Remember, doctors don’t have superpowers; we can become ill just like everyone else. It is vital to protect your mental wellbeing with the same tenacity as your physical wellbeing. Right in this moment, we’d like you to reflect on what short-term AND long-term goals you can aim towards to improve your mental wellbeing throughout the mental ramifications of COVID-19. We’ll leave you with this quote: “Trust who and what you are, and the universe will support you in miraculous ways”.(5) Until next time, Melanin Medics Written by Nina Sowemimo, 4th Year Medical Student, University of Leeds Helpful Resources 1.https://www.bma.org.uk/advice-and-support/your-wellbeing/wellbeing-support-services/sources-of-support-for-your-wellbeing 2. https://www.rcpch.ac.uk/resources/where-go-help-support-doctors-wellbeing 3. https://www.nhs.uk/service-search/find-a-psychological-therapies-service/ 4. https://www.headspace.com/mindfulness 5. https://www.calm.com/ References 1. 2020. Melanin Medics. https://www.melaninmedics.com/mind-us-project 2. Royal College of Psychiatrists. COVID-19 Guidance on Risk Mitigation for BAME Staff in Mental Healthcare Settings. https://www.rcpsych.ac.uk/about-us/responding-to-covid-19/responding-to-covid-19-guidance-for-clinicians/risk-mitigation-for-bame-staff 3. Oxford English Dictionary 2020. 4. Hardeman RR, Perry SP, Phelan, SM, Przedworski JM, Burgess DJ, Ryn MV. Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. Journal of Racial and Ethnic Health Disparities. 2016. 3(2), 250-258. 5. 2020. Alan Cohen. https://quotefancy.com/quote/761108/Alan-Cohen-Trust-who-and-what-you-are-and-the-universe-will-support-you-in-miraculous

WEDNESDAY It is the middle of the week, and things are in full swing on the ward. I am currently working as an SHO doctor on a general medicine ward in a hospital in Surrey. We see a variety of patients from psychiatry and neurology, to cardiology and gastroenterology. Now we are also seeing COVID positive patients. I have been here for four months and absolutely love it! I get along really well with my colleagues, including doctors, nurses, healthcare assistants, pharmacists and the therapists. We are literally like a big family on our ward, but unfortunately my time here is coming to an end in a few days, as permanent doctors will be starting on the ward. Today we had a new admission. A 62-year-old lady was admitted feeling increasingly lethargic with some unintentional weight loss in the past few weeks. Her blood tests revealed a high calcium (this is usually suspicious for malignancy) and raised CRP. She was booked for an urgent CT chest, abdomen and pelvis. The CT confirmed the presence of a uterine mass with metastatic changes in her lungs and adrenal glands. I informed the patient that the scan was suggestive of cancer - most likely endometrial. Unfortunately, due to visiting restrictions on the ward, she was alone whilst receiving this information, but I updated her husband and daughter via telephone. It was difficult to give them this news over the phone knowing that they could not see her. She was referred to the gynaecology team and they added her to the Gynae MDT list for discussion. THURSDAY This week my patients have remained the same. There are a lot of medically fit patients awaiting placement in a nursing or care home, or their package of care. I am also looking after a 27-year-old lady in her who was unfortunately recently diagnosed with metastatic melanoma of her right thigh. She came in with a headache and persistent vomiting four days after completing her fourth cycle of immunotherapy. She was prescribed antiemetics and rehydrated with IV fluids. However, despite this she continued to feel nauseous and her electrolytes became increasingly deranged. I discussed her with her oncology team at another hospital and they suggested requesting an MRI brain. The MRI revealed an immunotherapy induced hypophysitis. This is a disorder of the pituitary gland where the immune cells infiltrate the pituitary gland, in her case it is caused by her immunotherapy treatment. This produces a mass effect, which can lead to hormonal dysfunction, impingement of the optic chiasm leading to visual problems. The inflammatory process devastates the pituitary gland leading to adrenal insufficiency, hypothyroidism, hypogonadism, and diabetes insipidus. This explained a lot of her symptoms. She was discussed with Endocrinology. She was started on a high dose of steroids, quickly improved and was well enough to be discharged to be followed up with endocrinology and her oncology team. FRIDAY Today is bittersweet. I am so happy to have the weekend off, but on the other hand it is my last day here. My colleagues arranged for pizza to be ordered in and I brought in some cakes and snacks, so we had a mini leaving party in the staff room. I said my goodbyes, but of course it would not be a Friday without something to throw a spanner in the works at 4:30pm. Apart from the last-minute discharges to prepare for the weekend, this Friday was pretty smooth sailing, and I was able to leave on time by 5pm. Thank God it’s Friday! Thanks to COVID my plans for the weekend include sleep, catching up on some episodes of Sister Sister on Netflix and live streaming church service on Sunday. MONDAY Today I started my new job at a hospital in Kent. The commute was not too bad, a forty-minute journey on the motorway. I arrived and reported to my new ward. It’s a COVID ward. Kent is currently in Tier 3 and this second wave has seen a lot more admissions than even the first wave. Unfortunately, a lot of staff members have also had to self-isolate due to catching coronavirus and this is one of the reasons I was employed. The ward I was working on had no junior doctors on the ward. Which meant it was just me, the consultant and the poor final year medical student roped in to also help with jobs. Luckily, they pulled some other doctors from other wards to help out. Today was overwhelming to say the least. I had about five different logins for multiple different computer systems. After saying ‘in my old hospital, everything was on one system, it made everything so much easier’ for the sixth time, I realised that I was probably sounding like a broken record to my new colleagues, and that I need to get used to how they do things in this hospital. 5pm came by so fast and I could not be happier. Unfortunately, due to road closures on the motorway, it took me about 2 hours to get home. Tomorrow will be better. TUESDAY Today the ward round went a lot smoother. I knew the patients a lot better and I was getting a hang of the hospital computer systems. My colleagues are really nice, they showed me where the hospital mess is, where staff can get free food and free hot drinks (this hospital gets a lot of donations, due to COVID). I asked to leave a bit earlier today, as I was part of a panel where I was representing Melanin Medics at an event held by the Bart’s Women in Medicine Society. This event was held over Zoom and we discussed cases of racism, sexism and mental health concerns amongst female doctors in the UK. There were six female doctors on the panel (I was the most junior), who were from different walks of life, it was a very insightful discussion which I thoroughly enjoyed. WEDNESDAY I am now halfway through the week, in my new job and I am definitely finding my feet here. It is the usual routine today. The majority of the patients are COVID positive and have thankfully remained stable. On Wednesdays I usually attend choir practice after work. The last one was for Black History Month and our performance was televised in October. However due to the fact I am now exposed to COVID patients I will not be able to join for the Christmas special, which is disappointing, however sacrifices do need to be made in order to help stop the spread! Written by FY3 (Anonymous), General Internal Medicine, Kent References Cover Image: Shutterstock. 2020. Available: https://www.shutterstock.com/video/clip-6645446-close-portrait-black-female-doctor-smiling-medical

Dear FY1s/Final Year Medical Students, Firstly congratulations on your graduation from medical school! Or if you're a final year preparing for graduation - hopefully these tips will help you out during your first days as a Foundation Doctor! As a result of the pandemic, 2020 has been a tough year to be a final year medical student. Despite the difficulties, you have survived and achieved what you set out to, all those years ago when you applied. Now that you are finally foundation doctors, here are some rules to help you along the way. Part 1: Clinical Commandments Commandment 1: I Will Be Organised This may sound like a basic one but I cannot stress enough the importance of being organised as a foundation doctor. An organised FY1 really does help make the ward run more smoothly and makes life easier for seniors. For the ward round, update the patient list and have enough copies for everyone. For each patient, look at the drug chart and see if it needs to be rewritten - there is nothing worse for the on call team than being bleeped to rewrite a drug chart! In a similar vein, make sure you prescribe all of your patients’ warfarin doses before you go home. Throughout the ward round, compile a list of jobs that need doing. Having a good, structured jobs list leads us to the second commandment: Commandment 2: I Will Prioritise When looking through your jobs list it is important to prioritise tasks. For example, it is a good idea to get scans requested and discussed as early as possible, as well as any urgent referrals to other specialties. As an FY1, you will frequently be asked about discharge summaries. Ensure that you prioritise the most time sensitive ones such as those for patients going home with dosette boxes - these often need to be in pharmacy before lunchtime for patients going home that day. Normally one of the lowest priority jobs is putting blood forms out for the next day as this is usually the last task done before going home. Prioritisation is equally important during on call shifts. You may get one bleep about a patient with cardiac-sounding chest pain, and another about prescribing a sleeping tablet. It is clear here which job takes priority, but what about when you receive two simultaneous bleeps about chest pain? Enter the third commandment: Commandment 3: I Will Always Ask For Help Remember that in medicine you are part of a team and help is always available. If you are swamped on your on call, ask your fellow FY1 or SHO for help. There are also other incredible sources of support such as nurse practitioners and the critical care outreach team. As an FY1 you are not expected to know it all. Always work within your own competence and escalate to your seniors as necessary. In appropriate cases (i.e. not when someone is about to arrest - put that 2222 call out immediately), make sure that you have done an initial assessment and management plan before escalating to your seniors. When it comes to assessing the acutely unwell patient, it is always a good idea to have a strong structure... Commandment 4: I Will Not Forget My A to E Throughout medical school we are constantly reminded of the A to E method of assessing patients, so we won’t list the details here. Just remember that this structure is useful because it ensures that you cover all bases and don’t miss anything out. Once you’ve completed your A to E, use the SBAR structure to handover or escalate. Commandment 5: I Will Make Technology My Friend Sometimes you will forget some of your A to E. Sometimes you will forget the protocol for the investigation and management of PEs. Sometimes you will forget which drugs need to be stopped in AKI. It happens, and it’s okay. There are many apps that have been created to help us out. From Pocket Dr to MDCalc, make use of tech available. Your trust may even have its own app or have its guideline available on the microguide app. For those of you that prefer books, The Oxford Handbook for the Foundation Programme is a good one to carry around. Part 2: The Self Care Commandments Commandment 6: I Will Eat Lunch This commandment refers to the need to take breaks. When you are FY1 the workload can seem overwhelming and the joblist endless. For this reason you may find yourself doing one more task before eating, then another, and another, until before you know it is 4pm and you haven’t eaten anything since breakfast, nor had any water or looked away from your computer screen! This non-stop attitude is not sustainable and can lead to burnout. Additionally, let’s not forget that old adage, tired doctors make mistakes. Commandment 7: I Will Leave Work on Time... ...Or as close to on time as is possible. This commandment follows on from taking breaks. Obviously there will be occasions when leaving promptly will not be possible. This usually occurs when starting a new rotation and getting to grips with the job, or if there is an emergency, or if it is just one of those crazily busy days. However, do not make a habit of leaving work late. Of course it is important to get all your jobs done but make sure you handover what needs to be handed over and go home. Just as not taking a break will cause burnout, so will staying late for two hours everyday. Commandment 8: I Will Not Take Work Home With Me Once you do get home, try not to think about work. Maintaining a good work-life balance is incredibly important for your wellbeing and longevity as a doctor. Medicine can sometimes seem all encompassing but remember that you are a well-rounded individual with multiple interests and hobbies. Do not forget about them. From yoga to choir, all of these activities help make you a resilient and happy doctor. Commandment 9: I Will Keep My Portfolio Up to Date There is a lot of admin to do as an FY1 and letting it all pile up can make it an extremely stressful experience. From mini-CEXs to CBDs, there is a lot that you are required to get signed off. You can take the stress of portfolio demands away by regularly working on it. All it takes is 30 minutes every fortnight to have a stress-free end to the year. This advice also goes for any portfolios needed for subsequent applications. Collect evidence for your achievements as you go along because trying to get proof of something that you did two years ago can be a nightmare! Commandment 10: I Will Check My Pay and Rota The system is not perfect and sometimes mistakes are made regarding pay and your rota. Make sure you look at your payslip each month to check that you are receiving the right amount. The BMA can offer support for this as well as a free contract checking service for members. It is important to make sure that your rota is compliant and finally, to make sure that you are getting all of your annual leave! To conclude, these are the commandments of being an FY1. It is a tough, but enjoyable year and what you have been waiting for since applying to medical school. Don’t forget the advice given to you and that support is always available if you need it. You’ve got this! Written By Katy Chisenga, Clinical Fellow in Geriatrics References Cover Image ref: Shuttershock 2020. Black Man Doctor. [Accessed 12/12/2020] https://www.shutterstock.com/search/black+man+doctor

MONDAY... My Monday started off a little differently this week. Normally, on Mondays in this academic year, I’d have online lectures (which used to be face-to-face on campus, but COVID-19 said otherwise!), followed by writing up my study notes for the week. This time however, I was in London for the weekend, so after attending my online morning lectures on Genitourinary Emergencies and Urinary Incontinence, I then made my way back to my University home which is approximately a 2 hour journey. I guess one of the benefits of live online lectures this year is the freedom to access it anywhere – especially when you wake up 30 seconds before a 9am lecture and you’re quickly scrambling to log in before it starts! Once I had arrived, unpacked and overcome some procrastination, I continued making my notes on the medical conditions and learning objectives that we were expected to study for the week. I normally do this in advance of the GP placements that we have every Tuesday; not only for my knowledge in discussions, specific patient history-taking and clinical examinations, but also so I can withstand being grilled by questions from my GP tutor! I am currently in my last week of studying Urology in the module of Endocrinology, Urology and Renal Medicine which is an 8 week module. Following this, we have many weeks of secondary care (hospital) placement and an OSCE which tests our clinical skills for that module. Immediately after this, I then have the ENT, Ophthalmology and Neurology module followed by the Gastroenterology and Surgery module. In my medical school, we start GP placements and hospital placements from literally the first week of first year, meaning very early patient contact; alongside PBL sessions, lectures/seminars, and other countless compulsory components we have to complete (such as medical research and audits). With the sheer amount of specialities and content that we need to study, this third year in my medical school is notoriously known for being the hardest out of the entire Medicine degree, so you can already imagine the energy levels and work-rate I’m running on! TUESDAY... Tuesdays in third year are GP placement days. Each PBL group (10 people that you are grouped with for the year) attend an allocated GP, with a GP tutor. Apart from the extremely early wake ups and getting home half-asleep and drained, these are actually one of my favourite days in medical school! For me, it’s the freedom to speak to and get to know patients, take their histories, clinically examine them, perform procedures and practice with medical equipment, which I love doing. Sometimes we do ‘hot clinics’ alone, whereby each person undertakes the role of the GP doctor for the afternoon, manage patients who have booked urgent appointments, and report back to our GP tutors. Since we have learned to do all this from very early on, it’s not seen as daunting anymore, and it’s almost like learning how to drive. I’d say it takes lots of practice and confidence. Today, we started off the morning by reviewing some Urology topics, before meeting and speaking to patients face-to-face. The patients I saw had prostate cancer and benign prostatic hyperplasia. After introducing myself and gaining consent to speak to the patients (vital to do every time before talking to patients!), I took their history, but I didn’t examine the prostate as we were told by our GP tutor not to carry out prostate examinations today – otherwise each patient would have about five people all examining their prostate (not very comfortable!). Then, I had a telephone appointment (a recurring theme in GPs due to COVID-19) with a young female patient suffering from recurrent urinary tract infections. After speaking to these patients, I summarised the patient histories to my GP tutor and the rest of the group, as well as discussing their management plan, and any relevant points from the patient cases. The evening was much more hectic. Since our OSCE is fast approaching and this was our last GP placement for the module, there was no better way than to finish off with a mock OSCE. Whether an OSCE is the real thing or a mock version, your heart will still race because it’s so brutal! In different ‘stations’ under time pressure, we were all examined on emergency situations relevant to the module, performing the thyroid status exam, the renal examination and prostate examination. After a long day, it was finally home-time. WEDNESDAY... Our anatomy sessions used to be on Wednesdays. In anatomy, we study and dissect cadavers (dead human bodies). This has moved online and is now on certain dates for the time-being. So, this academic year on Wednesdays, we have online PBL on Zoom. Each PBL group has their own PBL session running from 9am-12pm. During PBL sessions within your PBL group, each person presents and discusses their learning objective which they were assigned to research for the week - this could be via PowerPoints, Kahoots, Q&As etc., and this may be a medical condition. PBL sessions each week are related to the specific week of the module that we would be studying at the time. This week, I presented a PowerPoint with a Q&A on the topic of testicular cancers. Next, we discuss the following week’s patient case-scenarios and learning objectives. Since it’s our final PBL session for this module, we ended the session with constructive feedback of how PBL has gone so far, and improvements to make for the next module of PBL sessions. At 1pm, it was time for clinical relevance (online again!). This involves a lecture from a consultant who summarises and consolidates everything that we should know for the week we have just studied, relating it all to real-life patients, and how we should be managing them as doctors in the hospital and in GP. Wednesdays are half days in my university, so pre-COVID times, this would be the day to do sports in the afternoon or just have the day to yourself. Personally, I would use the rest of the day to catch up on sleep! Especially if we had 8am anatomy sessions, or currently, the 9am PBL sessions. On other days, I may use it to run errands or have a self-care day. Today, I opted for a much-needed self-care day, but in the evening, I attended an online module revision session on Renal medicine and Urology. THURSDAY... This week, we were returning to secondary care (hospital) placement for 4 weeks. This is for 5 days a week, from 9am-5pm. So, from today, these 4 weeks are going to focus on the specialities we have just studied - Endocrinology, Renal Medicine and Urology. The days consist of attending clinics, ward rounds, operating theatres, clinical skills practice, multidisciplinary team meetings and performing clinical procedures. The days are quite intense, but I generally enjoy them as we undertake and practice the duties of a doctor. My day started at 6.30am, with just about enough time to ‘eat’ before I went to campus. On mornings of placement, I actually just survive on hot chocolate to be very honest! Everyone in the year-group is assigned to different teaching hospitals organised by our medical school, so we all meet at campus every morning, ready for the coaches to take us to the different hospitals. Once I arrived, I met with my allocated group for placement. We were then greeted by the Urology consultants, who later took us to see patients in the Urology outpatient clinic for the morning. Apart from getting grilled by questions from the Urology consultant (you actually just get used to this – or not!), I had to interpret abdominal X-rays, as well as CT and MRI scans of the kidneys, ureters and bladder. I also observed and took notes of patient consultations, which included kidneys stones, bladder cancer and genital abnormalities. Throughout my time at the clinic, the consultant was trying to convince me to specialise in Urology when I become a doctor. Urology is incredibly interesting…but I can’t say I’m dying to specialise in it! In the afternoon, we learnt how to catheterise males and females (inserting a tube all the way into the bladder). My first attempt – I ended up splashing fake urine all over my tutor and leaving a puddle on the floor. But after a few more practices, it’s safe to say that I can now successfully catheterise! FRIDAY... Today I had a scheduled day off from hospital placement, so it was definitely my day to try and rest. But that didn’t last too long, because all the work I had to do was calling me to complete it…who else can relate to that feeling of guilt?! In terms of my week, it has been one of the more eventful weeks this academic term, since a lot in the medical school timetable has changed due to COVID-19 and lockdowns. But, now that the intense days of hospital placements have started again, I’m bracing myself for the short winter days! Written by Third Year Medical Student (Anonymous), Norwich Medical School (University of East Anglia) Cover Image Reference: https://www.ebony.com/life/nccu-grant-minority-health-disparities-2017/

Shortlisted Essay - 2020: A year of reflection, resilience and reform On 25th May 2020, the video of George Floyd’s killing drew fresh attention to the violence that Black people disproportionately suffer at the hands of the police, igniting a cascade of protests across the world, and bringing the Black Lives Matter movement back to the fore. For many in the Black community, this was a solitary example of the countless Black lives lost at the hands of the police every year. However, the egregious nature of the killing obliged those outside of the Black community to take notice, opening the door for a renewed discussion about the systemic racism and unconscious biases that remain pervasive in many Western institutions to this day. The death of George Floyd came almost four months after another public health emergency of international concern was declared by the World Health Organisation. The COVID-19 pandemic, which, to date, has claimed over one million lives worldwide, served to illuminate another significant public health concern: the extent of racial disparities in healthcare outcomes, which have also been longstanding in many Western nations. Soon after the virus took hold in the UK, it became apparent that Black people were dying at a much higher rate than their White counterparts. This finding was made explicit in Public Health England’s inquiry into disparities in the risk and outcomes of COVID-19, 1 in which Black men in the UK were found to be 4.2 times more likely to die from COVID-19 than White men, a finding that is likely attributable, at least in part, to the healthcare inequities that afflict many Black people in our society. Indeed, many of the NHS healthcare workers who died from the virus were also Black men and women, further highlighting the ubiquitous nature of these injustices. Even in their place of work, Black people were not protected, resulting in the needless deaths of many who had worked tirelessly to save the lives of others. In spite of the many tragedies that have befallen the Black community this year, the world has been reminded of that which Black people possess: resilience. We have displayed indomitable strength, both as individuals and as a community, and indeed, the world has taken notice. Through peaceful protest, powerful speech and persuasive written word, we have made our voices heard, and have continued to speak truth to power, even after the myriad of black squares faded from our social media feeds. So how can this strength translate into our practice as healthcare professionals? Esteemed Jamaican physician and activist, Dr Harold Moody, wrote in 1932: “[We must] identify ourselves with the masses and make their inaudible cry our own.” As Black African and Caribbean doctors practicing here in the UK, we are in a position to raise up the voices that often go unheard in society, allowing their voices to ring among those which often overpower the conversation. Countless studies have identified how an individual’s Blackness can affect the care they receive, either through implicit bias, or ill-conceived assumptions about Black people’s bodies. It is therefore our role as representatives of the Black community within this system, to highlight these shortcomings, and push for a much needed and vastly overdue change. Systemic reform is vital for the equitable treatment of Black people within our healthcare system, yet, this change cannot occur without those who have an understanding of the nuanced complexity of implicit bias having a seat at the table. After years of independent inquiries into race being conducted by those outside of the community, this year has seen important changes to this precedent. Professor Kevin Fenton of Public Health England, who is of Jamaican descent, headed the inquiry into the racial disparities in COVID-19 outcomes, and the Royal College of Obstetricians & Gynaecology (RCOG) Race Equality Taskforce is being co-chaired by Dr Christine Ekechi, a prominent Obstetrician and Gynaecologist of Black African descent – two huge steps in the right direction. While these taskforces operate at a national level, we can each do our part to shed light on these important issues locally – at our universities, in our places of work, and within the communities in which we live. An example of how such efforts can be transformative is the FIVEXMORE campaign, which was created by two Black women, Tinuke and Clo, to highlight the degree of internal healthcare inequity in the UK. Through a number of successful campaigns that raised the profile of this important movement, this organisation is now working alongside the RCOG Race Equality Taskforce in order to examine and address the racial disparities in maternal healthcare outcomes that were highlighted by the MBRRACE-UK report. Their story is a testament to what can be achieved with true determination, and serves as an example of how change can come from consistency and perseverance. While much of 2020 has been characterised by adversity, I remain encouraged by the strides that have been made by many inspirational people of African and Caribbean descent during this difficult year. We can all learn from their actions, and approach our work with the knowledge that we can all make a difference, no matter how small we deem those differences to be. Even starting the conversation is a worthy action, as change cannot come without the wider acknowledgement of these issues within our society. We still have a long way to go in the pursuit of equality, not only for us as Black doctors operating within the British healthcare system, but also for our patients within the Black community, who we hope to serve. But as Dr Martin Robison Delany, one of America’s first Harvard-educated Black physicians, once wrote:“Our elevation must be the result of self-efforts and work of our own hands. No other human power can accomplish it. If we but determine it shall be so, it will be so.” Written By Dr Melanie Etti, Clinical Research Fellow in Microbiology, (Reference List Included) Shortlisted Essay The year 2020 has been another pivotal year in the history of African and Caribbean people. As a diaspora, we have felt a collective frustration as we have watched the cumulative failures towards our community be unveiled in plain sight to the world. In the realm of healthcare, the horrifying statistics of the fivefold increase in maternal mortality during childbirth, and the fourfold increase of death as a result of Covid-19 in comparison to our white counterparts have been laid bare for all to see. It has been instilled in us, as training healthcare professionals, that our patients should always be our first priority. We have been taught to provide care in ways which aim to minimise harm and act with the best interests of the patient at heart. From these statistics, we are able to conclude that we are currently operating within a system, designed in theory to be impartial but in actuality, operating in bias. Given the gross disparities in healthcare outcomes, it raises the question of the effectiveness of our medical practice in relation to black individuals. Although it has the potential to be overwhelming, we cannot and should not let ourselves be paralysed by despair when faced with the enormity of the challenge ahead. These statistics, shocking as they may be, allow us all to have baseline objective measures. Which, moving forward, have the potential to serve as valuable reference points, allowing for the impartial and tangible evaluation of the effectiveness of any future actionable points. They remind us that there is a fundamental shift in mindset needed, as comfort and familiarity, though good at times, also have the potential to be the biggest enemies of progress. Operating from the perspective of guilt never has and never will be sustainable way to achieve long lasting change. Habits can be extremely hard to break, and granted although complacency at this stage is inexcusable, the dismantling and rebuilding of these systemic failures is not something that we can expect to happen overnight. It is therefore essential moving forward, to realise that every step taken towards revolutionising our delivery of healthcare is all part of the cycle of committing to change, regardless of the frustratingly slow and agonizing pace that seems to be associated with it. According to the General Medical Council’s Good Medical Practice guidance, we should treat both our colleagues and our patients fairly and without discrimination. However, when the issue of racism is broken down, we are able to see that it permeates into every facet of the lives of those experiencing it, both from the perspective of African and Caribbean healthcare professionals to the perspective of patients on the receiving end of our care. With an increasingly diversifying population, we cannot afford to be operating within systems where these biases go unchecked as it has the potential to endanger lives. It is crucial for us to be working within teams that are receptive to change, and who are willing to work collaboratively to help bring about a long-lasting change for the future. As a collective, we often operate within spaces where there are legitimate concerns of being unduly punished or ostracised by our colleagues when speaking out on racial issues. Therefore, cultures within workplaces and institutions need to be re-shaped to ensure that we do not feel more comfortable in biting our tongues for the sake other’s comfort than we do speaking out and taking a stand against the racism we face. There needs to be an emphasis on continuous re-evaluating and reflection and also, a firm rejection of the idea that there is a limit to the amount of change, growth or learning that can occur. In conclusion, we need to realise and accept the fact that historical amnesia has led us to where we are by ignoring the very problem which keeps poking its head out in various shapes and forms. In order to obtain any further growth, we cannot let that carry on, as it is a hindrance which creates self-sustaining barriers. Medical institutions hold the power to put actions and policies into place to ensure that we are educating ourselves holistically for the equal benefit of every patient. As a collective, we also have the ability to hold them responsible through the process of lobbying for the change we want to see. It must be ensured that we are giving and creating spaces for those who are wholeheartedly invested in the cause, making room for constructive dialogue and speaking up to hold people and institutions accountable for their actions. As people from African-Caribbean backgrounds we can offer insights into our experiences. We should, therefore, be at the forefront of the consultation and solution generating process to help tackle the most pressing issues facing our communities. Additionally, we should hold solace in the fact the we are a truly resilient community. Our collective effort in generating and mobilising the power that we have for our betterment is nothing short of phenomenal. Silence sometimes has the ability to lull us into false senses of security, so as long as we keep speaking out and speaking up, we should know that there will be people willing to listen. Finally, as a society, humankind has progressed in mind boggling ways over the course of centuries. So just imagine what would be in store for the future if everyone, regardless of race or socioeconomic background, was given all the opportunities they needed to fulfil their full potential. Written By Naa Amua Quaye, Cardiff University School of Medicine (Reference List Included) Shortlisted Essay: A REFLECTION ON HOW THE EVENTS OF 2020 HAVE AFFECTED THE AFRICAN AND CARIBBEAN COMMUNITY AND HOW UNDERSTANDING THIS IMPACT CAN IMPROVE OUR FUTURE MEDICAL PRACTICE The events of 2020 have uncovered the true fragility of our society. A global standstill imposed by COVID-19 and the insurgence of the Black Lives Matter (BLM) movement have sparked economic crises, social unrest and interpersonal conflict across the globe. Although systemic racism in the UK is inherently covert in nature, the death of George Floyd publicised the chronic, racial injustice that exists in the US and simultaneously has unveiled the racial inequality that still exists in the UK. The African and Caribbean community, and people of colour in general, have endured the synergistic effects of COVID-19 and racial inequality, thus have been disproportionately affected by the events of this year. Nevertheless, in the face of adversity, we must continue to reflect, learn and grow. I believe that 2020 has given us the tools to scrutinize the so called ‘meritocratic’ systems that we live in; the systems that supposedly advocate for equality and freedom yet feign ‘colour- blindness’ when race is mentioned. In this essay, I summarise my main learning points from this year. Although these are my own personal reflections, I recognise the importance of being honest and open to encourage further discussion, so I hope these can be of use to anyone else wanting to join this railroad to justice. 1. Racism is about effect, not intent As a mixed-race woman, I believed that racism was about intent, thus ‘good’ people could not be racist. I was disillusioned by the events of 2020. Reni Eddo-Lodge writes ‘We tell ourselves that racism is about moral values, when instead it is about the survival strategy of systemic power.’ in her book, About Race 1 . Here, she acknowledges that racism is a far deeper issue than individual prejudice; instead, it is entrenched in the fabric of society and functions to preserve a power imbalance that exclusively disadvantages people of colour. We have to ask ourselves: why do Black Caribbean school children consistently perform lower than their white counterparts 2 ? Why are Black Caribbeans 3.8x more likely to be arrested and 3.7x more likely to be detained under the Mental Health Act than their white counterparts 2 ? To put it into perspective, Black Caribbeans make up only 1.1% of the population in England and Wales 2 . Nonetheless, in 2018/19 black people were almost 10 times more likely to be stopped and searched 2 . Akala posits that we live in a society where it is cheaper to send a young person to Eton than it is to incarcerate them, thus the current inequality is an issue of priority rather than resource. 3 Though this is not new information, it is imperative that we challenge these statistics and the structures that perpetuate them. 2. Racial inequality exists in healthcare. A powerful article by Olamide Dada summarises just a small part of the racial inequality that exists in the NHS 3 . Despite advocating for justice, non-maleficence and benevolence, we can clearly see that medicine is not exempt. Olamide outlines the disparity in the level of care received by black and white patients alike, and the shocking fact that 95% of the medical professionals that died in the first month of COVID-19 were black and ethnic minority. These statistics become relatively unsurprising when we examine the foundations of modern medicine. We are victims of selective academic omission; from the presentation of dermatological conditions and life-threatening skin colour changes on darker skin, to J. Marion Sims and his disturbing contribution to the field of gynaecology. Acknowledgement of this history is vital. Encouragingly, the events of 2020 have begun to initiate measure to diversify the medical curriculum and provide student-led EDI workshops. Additionally, a greater awareness of the challenges that people of colour face will allow for interventions to be made to negate the inequalities in healthcare. 3. Introspection is paramount Ignorance is forgivable, but apathy is unacceptable. We must identify the gaps in our knowledge, critique our innate, unconscious biases and self-reflect. We must recognise the insidious influence of the media; though it has been pivotal in the propagation of the BLM movement, we must not forget the condemnation of BLM protestors and the unsubstantial attribution of the (inevitable) second peak of COVID-19 to the movement. Again, this is not novel; the depiction of the black man as an inferior, aggressive and animalistic creature was popularised by Birth of a Nation (1915) and still very much exists today, though arguably more covertly. A pertinent barrier to change arises from the rhetoric that we live in a post-racial society in which personal success is awarded solely on merit. This narrative cleverly functions to negate the experiences of people of colour and attribute their relative disadvantage to character-driven personal failings rather than unfair structures descended from a legacy of slavery. The ‘If it ain’t broke, don’t fix it’ mindset is inherently flawed if one doesn’t take time to consider whether their experiences even qualify them to comment on the integrity of the system. Reni Eddo-Lodge describes how the challenges that disabled people face due to the inaccessibility of the public transport system only became visible to her once she was forced to use the stairs to transport her bike as part of her daily commute 4 . It is this kind of awakening that is the precursor to change. What can we do as healthcare professionals? We must use our platform to raise awareness of racial inequality; through service evaluations, workshops and open discussion. We can engage in outreach programmes like Melanin Medics - the epitome of positive action – which demonstrate the benefit of sharing knowledge and experiences within the African and Caribbean community. And, as humans? We should treasure any privilege we may have as it will be an important tool in our toolbox. Then, we must expand our toolbox by acquiring knowledge and listening to lived experiences. Finally, we must use these tools to make change. Individual change doesn’t have to be big. Instead, the compound effect of small changes will amass and will crack this power imbalance and permanently abolish the fossils of slavery. Written By Sarah Venning, Cardiff University School of Medicine (Reference List Included) Shortlisted Essay: Systemic Racism in UK Healthcare – Highlights from the Covid-19 Pandemic 1. COVID-19 - Trends in the UK’s African-Caribbean Communities Since its arrival in the UK, COVID-19 seemed to be taking its toll, disproportionately, on non-white ethnic majority (NWEM) communities – with the rates and risk of death in the UK’s African-Caribbean communities (ACCs) being the highest. The Table 1 data – from the Office of National Statistics (ONS) (2020) – estimated that, between 2 March and 15 May 2020, COVID-19-related mortality rates in black males and females were disproportionately higher relative to males and females of other ethnic groups – as high as 2.9 and 2.3, respectively – after adjusting for age. The data in Table 2 compares the mortality rates of different ethnic groups as an odds ratio in relation to the reference (white ethnic) group. Presented here are two sets of data for various ethnic groups, by sex, from the same period: age-adjusted and fully adjusted (Table 2). The fully adjusted data represents a calculation that takes into account socioeconomic, demographic, and geographic characteristics. The trend displayed by this data is similar to that seen in the age-adjusted columns: both black males and females had experienced the highest death rates – 2.0 and 1.4, respectively – when compared to the white ethnic male and female populations (ONS, 2020). Table 1: Age-standardised COVID-19-related mortality rate per 100,000, in males and females by ethnicity – based on data between 2 March 2020 and 15 May 2020 – retrieved from the Office of National Statistics (2020). The highest COVID-19-related mortality rates were observed in both black male and female groups, with the second highest rates associated with Bangladeshi and Pakistani males and females. Age adjustment is important considering that the strong association between COVID-19-related deaths and age had become evident during the initial emergence of the disease. With this in mind, and considering that different ethnic groups display different age distributions, standardising estimates with regards to age had increased data validity. The classification ‘Other’ includes Asian other, Arab and Other Ethnic Group categories. Table 2: UK Mortality rates, displayed as odds ratios, in NWEM groups, by sex, when compared to the white ethnic population; based on data between 2 March 2020 and 15 May 2020 – retrieved from the Office of National Statistics (2020). The white ethnic population were used as a reference group because this is the ethnicity with the largest population in England and Wales. The classification ‘Other’ includes Asian other, Arab and Other Ethnic Group categories. Two conclusions are inferable when comparing the age-adjusted with the fully-adjusted data in Table 2: 1) that additional unaccounted-for-factors had contributed to the increased risk of COIVD-19-realted death among the African-Caribbean population in England and Wales; and 2) that, given the marked differences between the two categories in both male and female subsets, socioeconomic, demographic and geographic characteristics had accounted for at least some portion of the mortality rates observed. A more recently published analysis by ONS gave consideration to the contribution of comorbidity – determined using both the 2011 Consensus and the 2017 NHS hospital episodes statistics (HES) – to the mortality rates observed across ethnic groups (ONS, 2020). This analysis purports a strong association between mental health illness and COVID-19-related mortality, relative to other comorbidities; with the prevalence rates of mental health illness being notably higher in Black Caribbean males and females (ONS, 2020). Understandably, there are some limitations to this data [e.g. the data was based on self-reported health and disability from the 2011 Census (ONS, 2020); this may have either underestimated or overestimated the data reported, due to the possibility of changes to ethnicity-related self-reporting within the past 9 years]; nevertheless, represented here are health inequalities – that is, avoidable differences in life expectancy, health, and/or wellbeing, between different groups of people, based on race, gender, socioeconomic status, or other differential categories – which are microcosmic of an inveterate psycho-societal phenomenon: systemic racism. 1. Lessons from COVID-19, Systemic Racism – The Need for Change Due to its pervasion within the different strata of society’s functional systems, the contribution of systemic racism to health and wellbeing outcomes within ACCs is complex. As applied to Dahlgren and Whitehead’s (1991) Social Model of Health – Figure 1 – systemic racism has contributed to nearly all social and ecological health determinants affecting ACCs. Figure 1: The role of systemic racism as applied to Dahlgren and Whitehead’s (1991) Social Model of Health. Systemic racism – defined here as the established adoption and implementation of racist ideology across the functional systems within a society – overlies the model’s general socioeconomic, cultural and environmental conditions; and thereby penetrates the downstream layers of categorical social and ecological determinants that contribute to health and wellbeing outcomes of the individual members of the ACC. Necessary to address here is the disparity in death rates between black ethnic (along with other NWEM groups) and white ethnic healthcare staff; reported between March and April 2020, 95% of doctors that had died of COVID-19 were from NWEM groups, despite making up only 44% of medical staff; the same trend was observed among other healthcare professions (British Medical Association, 2020). It is logical that part of the death rate experienced by ACCs could be explained by the occupations held by black ethnic individuals – with higher proportions of black males and females in care worker and care worker roles (ONS, 2020). Yet, this does not explain the extreme disproportionality observed; and so it would be equally logical to suspect systemic racism as a redounding factor. However, whilst complex, the effects of systemic racism on ACC health and wellbeing outcomes can be tackled with an equally effective systematic approach by the UK’s healthcare sector. Informing Current Practice through Improved Communication The value of communication within the healthcare setting is apodictic; it allows for positive patient experiences – which are linked to improved clinical effectiveness and patient safety (Doyle et al., 2013). Notwithstanding this, effective communication can only be achieved once the barriers to communication have been expunged. As applied to ACCs, this would be evidenced by healthcare trusts engaging with the communities to address specific concerns and attitudes relating to health and wellbeing. Strategies such as workshops, surveys and focus groups – where all community members have the opportunity to participate, including ACC healthcare professionals – are possible ways to ensure this. Data published by the Caribbean and African Health Network (CAHN), anent the impact of COVID-19 on the African-Caribbean community in Manchester, indicated numerous concerns that seemed common amongst community members, including: the discrimination faced by frontline workers; and the reluctance to use mainstream services caused by a lack of trust and cultural sensitivity (CAHN, 2020). These results are quite telling, and may very well be reflective of a recurring pattern of concerns across the UK’s ACCs; regardless, it is clear that a simple survey was able to yield valuable information from the community. Should this, along with the other engagement strategies mentioned, be implemented by local healthcare systems, the results could be used to tailor medical practice in a way that improves health outcomes in ACCs. What this sort of community engagement presents is an opportunity for both healthcare professionals and lay community members to learn from and inform one another of their experiences and expectations, breaking down the barriers to communication even further and establishing partnerships that are driven less-so by systemic bias. Conclusion Modern healthcare systems are expected to act as facilitators to the improvement and maintenance of health and wellbeing outcomes at the level of the individual, the local community, and nationally. However, the data presented throughout the COVID-19 pandemic brings to light the issue of health inequalities as a product of systemic racism – and the impact of such on the UK’s African-Caribbean communities (ACCs). However, this pandemic has provided a serendipitous opportunity for the healthcare sector to target engagement strategies, that may break down communication barriers and improve health and wellbeing outcomes for ACCs more wholly. Written By Tariq Marsh-Henry, St George's University of London (Reference List Included)

As we celebrate Black History Month, Melanin Medics have had the privilege of interviewing some great individuals doing amazing things for the black community within the world of medicine. This week we had the pleasure of getting to know more about Dr Patrice Baptiste. Dr Baptiste founded a medical careers company in 2016 called Dream Smart Tutors and has a YouTube channel to support medics through their journey (aspiring medics, medical students and doctors). Please kindly introduce yourself and what you do? My name is Patrice and I am currently employed by my practice as a salaried GP, I work part-time and I have a number of roles alongside that. I started a Medical Careers company in 2016 called Dream Smart Tutors, and as well as that I am a GP tutor and an examiner for Queen Mary University and for the GMC. I also do some writing and I have recently had the opportunity to do some one-off pieces for Blue Stream Academy. Although it may look like a lot, thankfully they do not take up too much of my time and some of these roles are quite seasonal for example the examining, I can choose the days when I able to do them. I like this because it allows for flexibility and variety and allows me to enjoy doing them even more! Tell me a bit more about your journey into medicine From the age of 4 or 5 I always wanted to be a doctor, I don’t know if there was anything in particular that helped me make this decision but I think it was more of a combination of the things I saw growing up. My school wasn’t the greatest (but it wasn’t the worst), it was a comprehensive school and it wasn’t really equipped to support students that wanted to apply for competitive courses such as medicine. I have a very supportive family and luckily my dad worked in a private hospital and I was able to get work experience which helped my application stand out. My teachers were supportive, but at the same time I always had that focus, and I was sure that I was going to do medicine. I got into University College London to do medicine, which is where it all began. I also did my BSc in Speech Science and Communication. So my journey into medicine was more of a linear path, however after medical school I went onto complete my foundation training and then took a gap year in the form of an F3 year. During this time I actually thought about leaving medicine. I took some time to think about my career in medicine and the reason why I did not want to continue with it. This was around the time of the change in the junior contracts and so I soon realised it wasn't me, it was the NHS. Once I discovered this I had to think about how I wanted my career to look. I then decided to become a GP. What inspired you to start this initiative/project? I am passionate about teaching, possibly due to the experiences I have had in the past from school to medical school. I have had good and bad teachers. I really never want students to feel nervous or embarrassed, this is not a conducive learning environment. I started volunteering at my old school and at other schools to help reviewing personal statements and doing some teaching. As I went through these experiences I realised there was a need for supportive services for young people who need research and advice into getting into medical school, which was also a part of the reason why I started my YouTube channel. I also wanted to go back to all of the things that I enjoyed doing and one of those things was writing. I had written so many poems (and I have actually self-published a poetry book this year!) I submitted an article to GP online and they asked me to start writing for them. What has been the most rewarding part of this project so far? The most rewarding part is being able to help someone. As a GP, you get to treat people's issues and as you talk to them more you can dig deeper and find out there is so much more going on. Not only can we help in a pharmacological way but also a lot of the time psychologically as well. I just really enjoy seeing someone’s quality of life improve even from just a small adjustment. So what does a typical week look like for you? My typical week includes a combination of clinics and writing. I work two and a half days a week, and the rest of the time I can work on my own projects. I am working on a few books at the moment. Currently I am crocheting a blanket, I also do a bit of yoga and also of course my lesson planning. How are you able to balance this with your work commitments? I always rely on a to-do list. I prioritise and stagger my work and I will start on a project or assignment quite early on. For example if I have to do a presentation at the end of the month, I will start it early on in the month and just keep adding to it. I am not very good at doing things last minute and get quite anxious doing things under pressure, so spreading out my commitments works best for me. Where do you see yourself and/or your project in the next 10 years? My hope is that they would be more established. Even with my YouTube channel I have been doing some re-branding and hope that it is able to reach more people. I would also like to do more writing, more teaching and possibly a masters in Medical Education, since I enjoy teaching so much, it would be good to get a qualification in it. Since I've become a doctor and GP, I've achieved my main goals so I believe that everything else is a bonus! What developments in medicine would you like to see in the next 10 years? I would definitely like the system to listen to trainees and doctors more so that they feel more valued. I would like to see more opportunities for less than full-time training and job sharing. I feel this way they will be able to retain doctors more, as we know retention of doctors (especially middle grade doctors) is an issue in the UK. But we must stay positive! If you have any advice for our current medical students and aspiring medics, what would it be? Advice for current medics or aspiring medics, would be to think about what you enjoy and who you are as a person. Think about what kind of life you would want to have in the future. What are the practical things of the career that will draw you to it and be open minded. Another would be to stop worrying. It is so easy to say however not so easy to do. I remember at medical school I was always worrying about passing exams, worrying about publications, or what I would do over the summer. So looking back I can definitely say that I have let a lot of worries go. What is the best way to support or get involved with your project? Please subscribe to my YouTube channel called Dr. P. Baptiste. Check out the Dream Smart Tutors website and you can follow me on Instagram: @drbaptiste and LinkedIn: Dr Patrice Baptiste. With thanks to Dr Patrice Baptiste for taking the time to chat to us, keep doing the amazing things you're doing! YouTube Channel: https://www.youtube.com/channel/UCXn5IGCUVcH5sGIJZrtArUQ Website: https://dreamsmarttutors.co.uk/ Instagram: @drbaptiste Twitter: @drpbaptiste LinkedIn: Dr Patrice Baptiste

During Black History Month, Melanin Medics have had the privilege of interviewing influential individuals who are doing extraordinary work for the black community, within the field of medicine. This week we had the pleasure of talking to Dr Kaylita Chantiluke: a paediatric registrar in Melbourne and the organisations lead of dftbskindeep.com. Please kindly introduce yourself and what you do? My name is Dr Kaylita Chantiluke and I’m currently a paediatric registrar in Melbourne, Australia. I am the organisations lead at @dftbskindeep, an initiative aimed to provide a free, open-access bank to photographs of medical conditions in the paediatric population in a range of skin tones; led by Don’t Forget The Bubbles (DFTB) and Royal London Hospital (RLH). I also have a blog with over 13,000 total views @musings_of_a_black_medic, https://kaylitac.wixsite.com/website. Tell me a bit more about your journey into medicine I know it’s a bit cliché, but I’ve always wanted to do Medicine, and I’ve always wanted to be a paediatrician. I would say this stemmed from a drive that I’ve always had from primary school, and this was useful as it guided my GCSE and A-level choices. My mum is also a paediatric nurse, so I’d spend time on the wards with her and her colleagues, whenever my father, my sisters and I would pick her up at the end of her shift. Most children find hospitals scary, but I’ve always felt comfortable in the hospital environment. I did pre-clinical Medicine and went onto study Medicine at the University of Oxford. It was here that I noticed that I was a woman of colour in a very white dominated space. After my preclinical years, I deferred the remainder of my degree to do a PhD in Child and Adolescent Psychiatry, focusing mainly on neuroimaging, at King’s College London. What inspired you to contribute to these initiatives/projects? The Skin Deep project started as part of DFTB in 2020, by a team of paediatric emergency doctors in both Royal London Hospital and Sunshine Hospital in Australia. It is a global initiative with 300 images and over 20 submissions every day. I felt passionate about getting involved as I was astutely aware of the effects of racism in healthcare and the need for more diverse skin in medical educational resources. Skin Deep is a unique organisation as it focuses specifically on paediatric dermatological presentations. We are also fortunate enough to have links all over the world which enable us to include images of skin conditions and their presentations in a wide range of skin tones, including Indigenous Australians. My role is getting different organisations on board to support us and provide images e.g. Royal College of Paediatric and Child Health, British Association of Dermatologists, British Skin Foundation, Black Medical Society, Societi, the UK Kawasaki Disease Foundation, Eczema Association Australia and many more. I started my blog in January 2020. I have always been creative from a literary point of view and I had lots of thoughts on various topics which I felt needed a creative outlet. I write on topics such as medicine, racism and feminism as well as their intersectionality. I’ve had over 13,000 collective views on my most popular blog posts “Why the Best Medical Students Make the Worst Doctors” and “Sorry, But I Want a White Doctor”. What has been the most rewarding part of these projects so far? The most rewarding aspect of being organisations lead for Skin Deep is seeing how many people are using it as an educational resource, like my own work colleagues and the organisations we’re working with. We’re creating a resource that is unlike any others out there, as it is specific to paediatrics. I’ve actually used the resource myself when working in the paediatric ED, where I found myself treating a dark skinned child with a burn. I remember researching “superficial burn black skin” and being faced with endless results of burns on pale skin. Using Skin Deep helped me in this situation, and showed me how my own work is changing my own practice. It’s such a vital resource. In terms of my blog, the most rewarding part of it is knowing that something I created has had the ability to change peoples’ minds and thought processes for the better. I have even had people reach out to me and say, “I really needed to hear that today”. Those positive words make me feel empowered to change systems in place that make things difficult for people of colour (POC). So what does a typical week look like for you? It’s still a strict lockdown in Melbourne in response to COVID so things are a little different than usual. My typical week includes 4-5 10hr shifts a week on paediatric medicine. I’m also heavily involved in academic research and currently doing a neonatal hypothyroidism audit, in addition to working on several other papers pertaining to race and racism within medicine. I normally spend the rest of my time working on my commitments at Skin Deep, where I manage a subcommittee team. I enjoy exercising 3 or 4 times a week and I have also been learning Spanish for 2 years. Other than that, I am revising for Part 2 of my paediatrics exam! How are you able to balance this with your work commitments? My system involves the psychological process of intervention – counselling. I would recommend it to everybody. We always look after our body. Going to the gym or going for runs is normalised, and if you ask someone why they’re exercising they’ll usually respond and say it’s preventative i.e. to maintain physical health. I think we should do the same with our mental health. Since doing counselling I have been able to reflect upon how I can give myself time to rest despite my busy schedule. Often, I have to check myself and ask myself – why are you doing this particular “To Do” task? Is this important and do you need to do it right now, or could you take some time for yourself? I find that, as medics, most of us are overachievers and leave little time to relax. We work so hard that I think if we want a day where we want to sit and watch Netflix and chill, we should be allowed! Where do you see yourself and/or your project in the next 10 years? Wow. That’s a good question. In 10 years, I see myself in Scotland doing academic paediatric neurology, split between clinical and research. I also see myself married, with a nice family and a nice little life! In 10 years, I hope Skin Deep can be the equivalent of paediatric DermNetNZ in regard to its scope and popularity. I hope it will provide a unique paediatric angle and be significantly more diverse than existing educational resources. We are hoping to get to the stage where we will have a range of skin tones for each condition – from lightest to darkest, to show a spectrum of what the disease may look like. I also imagine we’ll be using a lot more advanced technology to fit in with the current direction the ‘digital world’ is heading in. What developments in medicine would you like to see in the next 10 years? I’d like to see significant structural changes made to decolonise the healthcare system and make it a more equitable place for POC who are patients and/or working in the healthcare system. I feel like there’s been a lot of chat – but this is nothing if it’s not followed by action. When I’m a professor of paediatric neurology, I hope to look out and see a lecture theatre that’s representative of whichever country I am working in. I hope to see people of all skin colours and socio-economic backgrounds. I hope to see students with physical disabilities that do not have to sit isolated at the top of the lecture theatre because of their wheelchair. I hope to see individuals that can wear clothing that fits their gender identity, and to wear that with pride. I would like for everyone to have the same opportunities regardless of their background or circumstances. If you have any advice for our current medical students and aspiring medics, what would it be? I have done a lot – achieved an intercalated PhD, moved to Israel to volunteer in Nazareth hospital and moved to Australia. Yet, through all of this, my word of advice would stay the same for everybody – you are enough. It’s taken a lot of time for me to come to this realisation as a lot of the time I think we believe our self-worth and productivity are intertwined, which should not be the case. Medicine is wonderful and tough, but remember, whichever test you fail or whichever job you don’t get, you are enough. As you are, and right now, you are enough. You are valuable and important. What is the best way to support or get involved with your project? Promo would be super helpful! Please spread the word about Skin Deep, especially if you know anyone who is eligible or able to submit pictures, as anyone from the public can submit pictures. We also rely a lot on other hospitals for collaborations, so if you’re a medical student and you are interested in getting involved, please get in touch with a doctor or potential supervisor while you’re on placement and let them know about the work we’re doing! It would also be helpful if you would check out my blog @musings_of_a_black_medic and share with friends, colleagues, and people. I also have multiple journal article publications on ADHD/Autism which you can find on PubMed if you’re interested! With thanks to Dr Kaylita Chantiluke for taking the time to chat to us, keep doing the amazing work you're doing! Facebook: https://www.facebook.com/DFTBSkinDeep Instagram: @dftbskindeep Twitter: @DFTBSkinDeep

As we celebrate Black History Month, Melanin Medics has had the privilege of interviewing influential individuals who are doing extraordinary work for the black community, within the field of medicine. This week we had the pleasure of talking to Olamide Dada, the Founder and Chief Executive of Melanin Medics: an organisation for black current and aspiring medical students and doctors. Please kindly introduce yourself and what you do? My name is Olamide Dada and I am the Founder and Chief Executive of Melanin Medics. Melanin Medics advocates for black medical students, aspiring medical students, and doctors. As Chief Executive, I oversee the organisation’s activities and developments, as well as managing the team and taking part in public engagements on behalf of the charity. Tell me a bit more about your journey into medicine I always knew that I wanted to study medicine but I was not always confident that I would get in. The area that I grew up in was relatively deprived and I knew that if I wanted to maximise my chance of getting into medical school, it would be best to attend a sixth form in a different area. However, when starting at a new school, the teachers do not really know your track record. My new Chemistry teacher did not want to give me the predicted grade that I needed for medicine even though I had performed well at AS Level. This was a big blow for me because I had finally summoned the courage to apply for a place at medical school, but it felt like that decision was now in the hands of a chemistry teacher. This was not fair and luckily my dad intervened! He spoke to the Head of Sixth Form who changed my predicted grades. I ended up achieving those predicted grades, getting three interviews and two offers, and I am now in my final year of medical school. What inspired you to start this initiative/project? At the beginning of Year 13, I found my mentor, a black female GP who had grown up in the same area as me. She was extremely influential in my medical application process. When I got to medical school, I remember looking around the lecture hall and wondering where all the other black students were. I started to question why there were not so many of us. Was it because we were not applying? Was it because we lacked support? Was it because we did not think that we could get into medical school? What was the problem? I started Melanin Medics to address these issues and increase representation of African and Caribbean people in medicine. Initially, I wanted to help people successfully gain a place at medical school, so I started a weekly blog to share my experiences and tips. As time progressed, I realised that there was a lot more to the problem than met the eye and that there were many factors influencing representation in medicine, throughout a person’s medical career. This realisation triggered the growth of the organisation! What has been the most rewarding part of this project so far? That’s a difficult one! I’d have to say meeting people who don’t know that I am a part of Melanin Medics and hearing them talk positively about the charity. For example, I’ve met people in the lower years of my medical school who have benefited from our support and achieved a place at medical school. It’s wonderful to see the influence that we have had on people, even if only in a small way. So what does a typical week look like for you? As I’ve mentioned, I’m still at medical school so I attend my placement every day from 9-5. I normally wake up early and take some time for myself - no emails or notifications. The silent mornings are definitely the best part of my day! I then head into placement and usually fit in a lunchtime meeting or work on my to-do list. Once placement has finished, I go home and make dinner, and probably have another meeting. Next, I get on with studying. Finally, I make sure that I get in contact with at least one of my friends or family at some point in the evening. I also take time to do some reading for pleasure before bed. How are you able to balance this with your work commitments? Managing my time can sometimes be difficult as final year can be quite demanding. I like to be organised and know what I have coming up. I structure my week to make sure that meetings and other commitments do not impede on my studying time. I also have a triaging system to decide how urgent things are - must do today, must do tomorrow, must do this week. Additionally, I try to be intentional about doing things that I enjoy. I believe that there are enough hours in the day to do what is important to you, it’s all about priorities. Where do you see yourself and Melanin Medics in the next 10 years? I hope to be stable and settled in my career. I aspire to be a GP and so would like to think that I will have completed my training in ten years time. I am also interested in getting more involved in healthcare leadership and management, particularly in the area of diversity and inclusion. I would like to advocate for the health of black communities in policy and public health initiatives. I am also very passionate about creating resources and mentoring young leaders, particularly as I founded Melanin Medics when I was quite young. As for Melanin Medics, I see the organisation growing and having an international reach - specifically with regard to interactions with black doctors in North America who are also very underrepresented. Melanin Medics will redefine what it means to be a black doctor wherever you are. As black doctors, we have a lot of influence in our communities, often without even realising it. It is therefore important that we spread positive images of what it means to be a black doctor and advocate for black patients. As for policy and medical education, I hope that our training gets established as a vital part of the medical school curriculum. We will also be in a position to continue to drive policy change and continue to promote diversity in medicine. What developments in medicine would you like to see in the next 10 years? In 10 years time, I would love for medicine to have made substantial progress in better understanding of how to support diverse groups in medicine, what it means to have a diverse workforce, and I would love for there to be more diverse leadership. I wish to see black current and future doctors thrive in their medical careers without being fearful of racism, discrimination, differential attainment and disciplinary action. The freedom to be their authentic selves! It would also be great to see more black people in academia and at the forefront of change. Equally, I would like to see a reduction in health inequalities as it affects the black population. If you have any advice for our current medical students and aspiring medics, what would it be? Remember that anything is possible. There are so many incredible resources available to guide you on your journey. There are also a lot of people who want to give back - you don’t have to look far to find a role model that looks like you! Believe in yourself because you are more than capable of achieving your hopes and dreams. What is the best way to support or get involved with your project? Follow us on our social media and donate to our organisation if you can! We also have many opportunities to volunteer through mentoring and outreach events - sign up to our Networks for more information! With thanks to our Founder and Chief Executive Olamide for taking the time to chat to us, keep doing the amazing work you're doing! Website Facebook Instagram Twitter

As we celebrate Black History Month, Melanin Medics have been lucky enough to interview several exceptional individuals who are doing amazing work to improve the health outcomes of the black community. This week we had the pleasure of talking to Dr Annabel Sowemimo, a junior doctor working hard to educate us all on the impact that different factors have on sexual and reproductive health in minority groups. Please kindly introduce yourself and what you do? My name is Dr Annabel Sowemimo and I’m a Community Sexual and Reproductive Health registrar. I work between gynae and sexual health clinics which usually involve unplanned pregnancy, miscarriage, endometriosis, termination of pregnancy and general gynaecological conditions. I also founded a collective – Decolonising Contraception, which aims to address the structural and historical determinants of sexual and reproductive health. Lastly, I’m a writer and I have a column for gal-dem called Decolonising Healthcare. Tell me a bit more about your journey into medicine Like most medics, I was introduced to medicine through family friends and my dad, who is a GP. When I was younger I had scoliosis and had to have back surgery at 14. Before the surgery, I wasn't really aware how much my life would change as a result as I now live with chronic pain. I'm glad I had the surgery but as a young person - nobody really explained the details to me as I think they thought I'd freak out. This made me realise that medical professionals are quite powerful people and how much we have a say, and how educated patients are can be very variable. Therefore we need to build more health literacy. I had this at the back of my mind when I went to medical school, but at the time I didn’t know much about the history of medicine and the different dynamics within medicine. I studied anthropology in my third year of medical school and after learning about the colonial history of medicine, I felt like there was a lot of ignorance around medicine. So I decided to start Decolonising Contraception to address that in my own sector. One reason why I decided to specialise in SRH is because I think it’s one of the specialities that is more open to change. I also felt like it aligned with a lot of my interests. Why Medical Anthropology? When I was applying to university I considered studying anthropology so I already had an idea of what it was. I’ve always had an interest in writing, I did English A-Level and have always enjoyed History and Drama. Intercalating in Medical Anthropology seemed like an opportunity to do something different and incorporate my love of writing into my medical career. During medical school, was it important to you to maintain your creativity? It was very important to me and luckily I was able to find creative outlets. I was on the drama committee and I directed plays at university until my third year. I was also the editor of the global health magazine and later, president of the society. One thing I found difficult about medical school is that I had so many other interests but our curriculum was so intense, but I managed to balance everything. What inspired you to start your company? It was partly out of frustration. When I went into my speciality I thought it would be different. I already knew the experiences of black women and reproductive health. It was weird to me because I felt as though no one was aware; I was faced with a lot of ignorance. Nobody seemed to connect the dots that it was the same demographic that didn’t go for their cervical smears, the same demographic that had poor health outcomes, had poor sexual health. I felt like everyone in my speciality sounded the same. I believed we needed new conversation. I wasn’t even sure if DC would work, how it would be received or if it would resonate with people. Up until six or seven months ago people found it uncomfortable to discuss decolonisation and it is only recently that the atmosphere around this has changed considerably. Why do you think things have things changed? Covid-19 and Black Lives Matter have meant that some people have had to do some internal reflection because there is no medical reason why people of different descent should be dying from Covid in such disproportionate numbers. People are being forced to reckon with the social determinants of health. But we already know that if you improve someone’s life circumstances, their health will inevitably get better. What has been the most rewarding part of this project so far? One thing I enjoy is connecting and engaging with medical students and younger doctors. I remember feeling really lonely in medical school, as no one else understood the problems I had with our syllabus. They didn’t understand how I felt towards medical school. Back then I didn’t really know what the problems were or how to articulate those feelings until now. I really find it rewarding when I see medical students who have been inspired by our work, going to start something at their university and challenging the status quo. For me this shows that my work is working. So what does a typical week look like for you? My days are quite varied as a CSRH trainee. It’s a combination of gynae clinics and sexual health clinics so this can range from a menopause and general gynae clinic to a termination of pregnancy and GUM clinic. I also have time to work on projects such as Quality Improvement Projects. Decolonising Contraception is a full time job in itself so I check my emails in the morning before work and at several other points during the day. I go to the gym a few times a week in the evening and from around 7 pm to 11 pm I do work for DC. On the weekends I’m usually writing an article or doing more DC work. How are you able to balance this with your work commitments? I don’t really have full days off; I usually have time off. For example, I might do work in the morning and give myself the rest of the day off. I’m lucky to have very understanding friends and family around me. I’m also getting better at delegating so we have different roles at DC, and I try to touch base with the different team members every few weeks. If you love something, you find time for it. I was coming to the end of my tether because things at Decolonising Contraception were becoming quite hard. But the love of something will push you to a point where you find reserves you didn’t know you had. You also need to remember that medicine is a marathon not a sprint. You don’t need to be busy all the time. Where do you see your company in the next 10 years? I hope that we are still around to advocate. I hope that more organisations are building the narrative that we discuss so we aren’t as necessary anymore. It’s a beautiful thing if your organisation ceases to exist, because it means the problem you set out to solve is cured. I would like Decolonising Contraception to have changed the conversation and I’d like to see this reflected in improving statistics in the UK. I’d like people to use some of our strategies and improve SRH globally. What developments in medicine would you like to see in the next 10 years? I hope that medical curriculums start to tell the truth and tell the actual history of medicine. We need to talk more about doctors themselves and their own prejudices and biases. If you have any advice for our current medical students and aspiring medics, what would it be? Don’t doubt your own capabilities. It’s very easy to get bogged down by self doubt at medical school because someone is always smarter than you or doing more than you. You are enough and you are good enough. Whatever happens at medical school does not define how you’ll be as a doctor. What is the best way to support or get involved with DC? We have projects that run throughout the year that we sometimes need volunteers for, so feel free to email if you’d like to get involved. We are also always looking for illustrators to work with. Sign up to our mailing list on our website. You can donate to us through our patreon and paypal. Check out our social media. We are always looking for youth organisations and universities to visit, so get in touch if you’d like us to speak. With thanks to Dr Annabel Sowemimo for taking the time to chat to us, keep doing the amazing work you're doing! Facebook: https://www.instagram.com/decolonisingcontraception/ Twitter: https://twitter.com/DecoloniseContr

As we celebrate Black History Month, Melanin Medics have the privilege of interviewing some great individuals doing amazing things for the black community within the world of medicine. This week we had the pleasure of getting to know more about Malone Mukwende who produced the resource called Mind the Gap: a handbook of clinical signs in black and brown skin. Please kindly introduce yourself and what you do? My name is Malone and I am a third year medical student. I study medicine at St George's, University in London. Aside from that, I am an Arsenal fan, and of course, I like to have fun! Tell me a bit more about your journey into medicine My journey into Medicine was very complicated and haphazard. I was actually rejected before interview stage by four medical schools – Birmingham, Nottingham, Leicester and Oxford. However, on results day, I was accepted into St. George’s to study Medicine, via clearing with 3A’s. So, I guess it all works out in the end. What inspired you to start this initiative/project? There were quite a few things that inspired me. Firstly, there was not any substantial teaching in my medical school about dermatological presentations on darker skin. I also found it ironic that, whenever I learnt content in dermatology, why is it that when I went onto the wards and met a patient with darker skin, I could not tell what their condition was? But, as soon as I saw a white patient, I instantly knew what condition they were presenting with. I was always second guessing the presentation and diagnosis in darker skinned people that I met on the wards, leading me to wonder why this was the case. From then, I was searching for answers from my lecturers. However, deep down, I knew that I would not get answers any time soon, so I wanted to do something about it. I wanted to create that answer. That is how Mind The Gap came into fruition. I always wrote down my ideas on paper, and I knew that I wanted to get this information out. Even though at some points, it felt as though I was ‘collecting scraps’ with lack of information and resources, I did not give up despite the difficulty of this project. What has been the most rewarding part of this project so far? It has been so heart-warming to see that Mind The Gap is revolutionising healthcare, and changing medical practice. It has been rewarding to see that people out there are genuinely being helped by Mind The Gap. For example, I recently received a handwritten letter from someone in Sweden praising Mind The Gap. Also, a GP has recently reached out to me to inform me that he has been using Mind The Gap, which is greatly supporting him in his practice. I am not even a qualified medical doctor yet, so it is honestly so rewarding! Mind The Gap is raising awareness in the medical world, and changing the bias that exists in healthcare. I always say, it makes me sleep at night, knowing that there is also someone out there who is sleeping at night because of Mind The Gap. So what does a typical week look like for you? Well, that is very hard to answer because of the current COVID-19 situation! My typical week is ever-changing. On Monday afternoons, I have Problem-Based Learning (PBL), whereby we discuss topic-specific case studies. Currently, we are learning about HIV and Malaria. On Tuesdays, I have lectures. On Wednesdays, I have clinical skills, in which I recently practiced venepuncture and drug prescribing. On Thursdays, we have lectures again, and on Fridays, we conclude our week again with PBL. How are you able to balance this with your work commitments? I am always asked this question and I believe that, everyone, including myself, has time. If I look at the screen time on my phone and see how many hours I have used, I realise that, I could have used even a few hours to do something more useful. Doing things to better myself every day, will eventually compound into something big. With small steps, you can always make progress. That is the same principle that I used for Mind The Gap. At medical school, no matter what stage I am at, I know that it is better to fulfil my responsibilities in the present moment, rather than later. This is to avoid my responsibilities building up too much. To sum it up, I read a very good quote recently: “time works against people with bad habits; but those with good habits have time on their side”. Where do you see yourself and/or your project in the next 10 years? Personally, I see myself just having fun! I just want to be happy in life, no matter where I am. In terms of Mind The Gap and the Black and Brown Skin website, I see them becoming the number one resource for images of clinical conditions on darker skin. Essentially, a comprehensive encyclopaedia with thousands of dermatological presentations on darker skin. What developments in medicine would you like to see in the next 10 years? I would like to see the medical world becoming more diverse and inclusive. Also, I would like to see medical professionals dismantle the biased and outdated medical ideologies used today, although established many years ago (justified by inhumane acts). I would like to see these developments rather than just accepting the outdated ideologies and the problems that we face today. If you have any advice for our current medical students and aspiring medics, what would it be? For current medical students, I would like to tell them that your voice and value is worth a lot more than you think. Sometimes, I feel as though we, as medical students, devalue ourselves because we think that we are at the bottom of the social hierarchy in terms of consultant levels, junior doctors etc. We actually have so much knowledge! So, we should always be courageous and know our worth. For aspiring medics, please know why you want to pursue medicine as a career. It is definitely not a straightforward road. In fact, it is sometimes very bumpy, so I advise that you make sure that you are certain on pursuing medicine. If you know why you’d like to study medicine, this reason will become your driving force when things start to get difficult during the process. What is the best way to support or get involved with your project? Please share, download and inform others about Mind the Gap handbook. There is also a feature on the Black and Brown Skin website that allows you to submit a non-identifiable image, relevant and appropriate for our website, about clinical skin conditions on darker skin. Or, you could share a story which will be posted on the website. These will start to get featured on the website from October, if you would like to get involved! With thanks to Malone Mukwende for taking the time to chat to us, keep doing the amazing work you're doing!