What’s Race Got to Do with It?: A Brief History of Race in Medicine and Surgery

The COVID-19 pandemic is loud and not leaving us anytime soon, and I’m sure we’ll never hear the end of the fact that this is “an unprecedented time in history”. There have been a lot of controversial topics ranted about, from whether masks actually work, to the slow response time of our hopeless government, to the bare state of the NHS - our national lifeline. But of course, in a time of high racial tension and police brutality, the most jarring part of this scary ‘flu’ - as the cynics call it - is the proportion of people of colour that are catching it or being exploited for research. I think it’s important that we not only pay attention to institutionalised racism and the violence inflicted on Black people by law enforcement and the justice system, but also the cruelty of the medical field towards them. The treatment of Black people today is not just limited to videos of callous police officers killing ceaselessly, but also behind the faded grey curtains of a hospital bed. COVID-19 is not the first instance, and I want to use it as a starting point to delve into the long disturbing history of doctors exploiting Black bodies.

Pre-Slavery

Colonial conquest and the subsequent slave trade exposed established African civilisations to Western imperial powers. These civilisations had their own way of living, their own vibrant, diverse cultures and medical protocol. They had their own methods of healing and used natural remedies and resources to aid the infirmary.

Several African nations used herbal medicine to heal the sick:

“herbal medicines include herbs, herbal materials, herbal preparations, and finished herbal products that contain parts of plants or other plant materials as active ingredients” [1].

They utilised the natural resources that were most accessible to them in the ecosystem they lived in, and they were often effective due to the chemicals that were inside them. The practices and types of herbs they used would vary from tribes and regions across the continent. In some regions, traditional ‘healers’ would holistically operate on patients: considering their social and mental states, not just their bodily ailments. Their cures and remedies were closely connected to spirituality and intangible realms, with heavy use of superstition, incantation, rituals, and charms. These healers were much revered, and their talents were seen as ordained from God. Much of these ceremonies and traditional medical practices continue to be used today and are in fact preserved as a key component of the culture; sometimes in order to combat western degradation and stigmatisation that has lingered from colonialism. 80% of African people still use traditional and herbal medicine [2].

Colonialism and Medical Experimentation

As Western empires encountered the diverse and unique cultures of Africa, they made sure to distinguish their difference and inferiority to that of the West. Emissaries called African traditional medical practices primitive and maligned them as witchcraft and thus illegitimate. Nevertheless, African populations were used to develop European medicine and surgery – Black bodies were the ‘blank slate’ for corrupt officials to practice on during the domination of slavery:

“no consensus existed that crossing an ethical line ought to be a central concern. It is worth recalling, in this respect, that medical research carried out in sub-Saharan Africa was not so unusual or extreme” [3].

Only recently in history has there been an effort to adhere to certain ethical standards and conserve some semblance of humanity in medical research. Prior to this, Western medical development was based on the mass extermination of Black people. Black bodies were used as collateral to save white lives and cure diseases that white people had through experimentation. Many errors and malfunctions inevitably occurred in these experiments, as Western doctors used drugs and techniques that had unknown effects, with slaves being treated as disposable test subjects.

Medicine and surgery were also used to confirm and corroborate white supremacy. Racist notions of Black people being biologically different and inferior to whites were supported by these horrific experiments, so they were viewed as entirely factual. For example, John Brown - a slave from Virginia – was used to determine that Black skin was thicker than white skin, and his body was cut into until he was deemed as useless to physicians. This vicious experiment was the literal manifestation of the notion that Black people have high or no pain tolerance at all and was used to dehumanise them even further [4]. There were even specialists on “black exclusive” diseases, such as Samuel Cartwright.

The “father of modern gynaecology”, James Marion Sims, was not even a gynaecologist and didn’t have any training as one [5]. He violated the bodies of 12 Black women to explore ‘vesicovaginal fistula’, a childbirth complication in which urine leaks involuntarily from the body. He operated inhumane surgeries on these women, some of them up to 30 times alone on one body, and all without anaesthesia. Once he set up a woman’s hospital in 1855, he used anaesthesia on white women. A statue of him was erected in New York’s Central Park from 1934 and, after much prompting from activist groups, was taken down in 2018.

This inhumane practice of using Black bodies for medical advancement continued well into the 20th century. A Black woman named Henrietta Lacks had her cells kept in a lab long after she died in 1951 of cervical cancer; the cells were collected from her cervix and they were exceptional because they reproduced themselves even after her death, making new ones every 24 hours. Scientists have since used these- what they called “HeLa Cells”- as the basis of genetic research into various illnesses and diseases: STDs, sickle cell, anaemia, leukaemia, Parkinson’s, haemophilia, polio, influenza and so much more. Lacks’ children were contacted by author Rebecca Skloot for a book she was writing on their mother, and they had said their cells were also used in the 1970s [6]. The family had not received any type of compensation since Henrietta’s death in 1951 and only got added to a review board for public access to the cells in 2013. They learned about the use of Henrietta’s cells in 1975 from a family friend and have even struggled to get access to healthcare in the past [7]. At the time of Lacks’ death, the infamous Tuskegee Syphilis Experiments were occurring, where African Americans were the subjects of a federal study on untreated syphilis. The subjects were told they would receive free healthcare in exchange for participating, when in fact they never received treatment or compensation and the study went on for 40 years.

Then vs Now

After all I have outlined, much of this is not in the bounds of common knowledge. It’s not taught in history or science lessons at school. I had only learned the name Henrietta Lacks in the last year. Scientific research has historically used Black people in general as subjects, and Africa as a giant petri dish for experimentation. But Black people have been exploited and abused both on the medical bed and behind it. The NHS, the very backbone and collective pride of the UK, was driven by immigrant nurses from the Caribbean and Africa, after the arrival of Windrush in 1948. After the Second World War, they were requested by the British government to fill up the shortage in the workforce. Even while caring for soldiers after the war, they were confronted by racial abuse from them, and had their qualifications from the Caribbean rejected [8].

On top of this, hospitals have not been the safest space for Black women; they are five times more likely to die in child labour than white women [9]. Black women have had generally negative experiences in the hospital environment, including being victims of implicit bias from medical professionals in the NHS and generally having more complications in childbirth [10]. Since Black people make up a lot of the NHS workforce, COVID has also had a chilling effect on them too. The case of nurse Mary Agyeiwaa Agyapong, who died during childbirth after contracting coronavirus while pregnant, is relevant here. Black people have also been found to be more likely to contract it: Black males have had the highest rate of COVID deaths, 2.7 times higher than white males [11]. Furthermore, the incidences of Belly Mujinga and Trevor Belle being spat at as essential workers, show that even in a pandemic, Black people are still being abused.

With the rampage of COVID-19, it is all the more evident that there lies a lot of inequality in the medical field, and that this racist history needs to be reckoned with finally. It is therefore not unexpected that Black people are suspicious of vaccines, hospitals and corrupt doctors with implicit biases. It is not constructive to immediately call these people anti-vaxxers or dismiss them as ignorant when this is the history that has tainted their views of healthcare in general. Western medicine has a racially violent legacy that has been obscured from general knowledge; and the practices, remedies, and research that goes into Western healthcare are built off the suffering of Black people.

 

Sources:

[1] https://www.hindawi.com/journals/ecam/2013/617459/  

[2] World Health Organization. WHO Traditional Medicine Strategy 2002-2005. Geneva: WHO Press; 2002 

[3] https://journalofethics.ama-assn.org/article/medicine-empires-and-ethics...

[4] https://www.nytimes.com/interactive/2019/08/14/magazine/racial-differenc...

[5] https://www.history.com/news/the-father-of-modern-gynecology-performed-s...

[6] https://www.history.com/news/rebecca-skloot-on-the-immortal-life-of-henr...

[7] https://qz.com/quartzy/1280775/the-most-important-detail-from-henrietta-...

[8] https://www.blackhistorymonth.org.uk/article/section/windrush-day-2018/c...

[9] https://www.npeu.ox.ac.uk/news/1642-mbrrace-uk-release-mbrrace-uk-saving...

[10] https://www.medicalnewstoday.com/articles/we-all-bleed-the-same-color-wh...

[11] https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarri...