How Can We Feel We Belong in a Place That Hasn't Welcomed Us?

How do we know we belong? Where are our safe spaces? How can we enact change in systems layered in racial inequity?

Health care is a space that traditionally hasn't done a good job of welcoming and equitably treating those who did not build the system. Looking at the statistics for racial representation among Black physicians against the general population gives some perspective on inequities in the medical field: In 2019, the Association of American Medical Colleges reported that only 5% of practicing physicians in the United States identified as Black or African American, while the 2020 census reported 14.2% of the US population identified as such (some identified as multiple races and ethnicities.)

Stories, poems and art can help us understand in new ways how people experience inequities, help connect us and inspire us to take action.

In the following pieces, Dr. Asma Adam ponders how a Muslim Somali women like herself can belong in a place where she is constantly questioned. Dr. Tseganesh Selameab explains the importance of having safe spaces to rest and rejuvenation in order to do the important work of racial health advocacy in an animation illustrated by Dr. Ankit Mehta. And Drs. Samantha Pace and Cuong Pham explain two approaches to health advocacy work in order to move the needle of justice.

The video poem above is written by Dr. Tolbert Jones Small, the first physician to the founding chapter of the Black Panther Party. The poem is called, "To the Healers (And Their Patients Who Have the Right to be Healed". As many members of our communities are healers, the poem is read by both physicians and community members to honor the work being done by so many.

By Dr. Tolbert Jones Small

We are healers.
We toiled for years to learn the mystery of the human body.
We nourish spirits from birth to the grave.
We mend the bones.
We sew the cuts.
We kill the pain.
We cool the fevers.
We soothe the spirits.

We are healers.
We bring new life.
We close old life.
We pick the herbs.
We needle away the pain.
We cut out the cancer.
We poison the germs.
We calm the troubled minds.

We are healers.
We treat the whole body as one universe.
We treat each part of this universe.
We keep the hearts pumping.
We keep the lungs breathing.
We know, as long as life exists,
We will be healers.

Dr. Tseganesh Selameab, story
Dr. Ankit Mehta, art
Carrie Clark, annimation

Looking at me you see how I appear to enter in space, a young-ish, black woman with a big smile and strong hand shake. What you don't see is the manifestation of my inner white man. Yes, you heard me — I have an inner white man. Joe became a part of my life the first time I put on a white coat in medical school. I had him knock first before we entered the exam room and had him sit next to me as I took a patient history. I channel him often when I have to explain, "No, I'm not the nurse," or that, "Yes, I have done this procedure before," and "No, of course I don't mind if you talk to another doctor about this." Medicine is a space designed to make me feel alone, uninvited, and constantly second guessing.

Joe is excellent at quieting the voices and glances that tell me I don't belong. He's expert at protecting me from the questions about my right to be here. Joe can pull up a seat at any of the tables and be made to feel welcome, even wanted. 

Listen, Joe is not the internalization of systemic sexism and racism that tells me my worth is only based on a scale of whiteness. Nor is he a demonizing of the while male narrative, I know every story is different, but my Joe serves a dual purpose. He reminds me of the systems that I live and work in and he's a powerful tool I can use to thrive in that environment. 

For example, Joe and I looked in the mirror this morning and made sure this dress didn't show too much cleavage and that it didn't hug my hips too tightly because I want to be judged by the content of my words and not the shape of my body. Joe also reminded me to push back my shoulders and stand assured that my words were important and my voice worth hearing.

When I make a mistake it's Joe's voice that reminds me that some will look at that error as further proof that brown, women physicians are just not quite as competent as their peers. Joe's voice will also be there to tell me that that is not my work. My work is to learn from my mistakes and continue to grow as a doctor and to improve my craft. My inner white man, my Joe, is my short hand.

Joe is also my systole. Systole is the powerful part of the cardiac cycle. Systole is a life-giving force that drives oxygen out of the heart and pushes it throughout the body. Systole is loud. And it often drowns out that brief silence of diastole.  

Colleen Farrell's opinion piece in JAMA talks about "seizing diastole". She says, "Medicine has taught me that there is wisdom in the body. If we would put our stethoscopes to our own chests, we would hear the pause of diastole. We would remember that during that pause there is work being done. A drop in pressure. Relaxation. Expansion. And then, with a full heart, a gush of life."

When I am in a space of diastole, I notice that my body relaxes. I breathe more fully and deeply and I feel myself expand to my fullest expression. My heart is full. So full that I can no longer accommodate Joe. I have expanded beyond the spaces that require his presence. 

Spaces of diastole are sacred and I have come to understand that they are formed through intention, and labor and are not "happy coincidences." My spaces of diastole include my clinic. I walk in and I am greeted by nurses and fellow physicians that reflect my lived experiences. My patients are a tapestry of new and old Americans woven together in a neighborhood full of history and promise. I work in a space where my voice and story are enough. I work in diastole.

Advocacy is systole — a powerful forward movement that seeks to make change on behalf of others.  In advocacy, just as in in life, systole requires diastole.

If we want the energy, the perseverance and power to seek change we need spaces of diastole where we can relax and be filled. We need spaces where we can expand to our fullest being, where we can heal, where we can thrive, and perform at our highest level. We need to become advocates for diastole.

By Asma Adam, MD

Her eyes brightened and her cheeks were rounded by her wide smile. She excitedly stood up from where she was playing and walked towards me as I entered the room. She gave me a long, unexpected hug.

"Salam, how are you?" I asked her.
"Are you my doctor?" She asked.
"Yes, yes I am!" — I responded, matching her excitement.
She then followed me as I sat down.

She reached for my royal blue hijab as she pointed to hers — bright orange and with sparkles. She was eager to share what she was learning in school, stories about her friends, and all the foods she was eating to help her grow. As I wrapped up our visit, she said, "I want to be a doctor just like you when I grow up."

Sometimes it's hard to remember the 'why' when so many days are filled with signals that I don't belong. Those quick glances down at my badge that says, "Doctor," back to my face, and then back to my badge again.

It's hard for me to accept that the white coat I'm wearing, my stethoscope around my neck, my multiple pagers beeping, and the patient list in my hand, are still not enough to shield me from the perception that I am out of place.

On those days — she is the 'why'. She — and many others — remind me why I've dedicated so much of my life, my time, my energy to be in the room with them as their doctor.

I often ask myself: "What does it mean to belong in medicine?" For me, belonging is not about conforming to the appearance of a typical doctor. Belonging is about changing the perception of what a "Doctor" looks like.

So, every time I get asked "Where are you really from?", I think of bright orange and sparkles. Every time I get surprised glances because I'm explaining life-changing diagnoses, or laying out complicated treatment plans, I think of patients with henna-speckled beards who agree with my treatment recommendations because of their faith and trust in my presence.

As I walk around the hospital with my stethoscope and my hijab, I know that I stand between two generations.

I want to inspire my young patients to dream of becoming intelligent and compassionate doctors. And I want to be worthy of the elders who beam with pride because their sacrifices and hopes have been realized.

If I do these things, I'll always know that I belong.

Knowing and admitting racial disparities exist in health care is the first step. But what are we doing with that information? How are we challenging the status quo and making change within the system?

Doctors Samantha Pace and Cuong Pham are taking action to combat injustice in health care in two very different ways:

After the murder of George Floyd, Dr. Samantha Pace and the OBGYN department at Hennepin Healthcare in Minneapolis didn't wait around to let their voices be heard over the injustice of the situation. Instead, they took action by partnering with medical students and Black Coats for Black Lives to arrange a demonstration.

Doctor Cuong Pham is a physician at Community-University Health Care Center (CUHCC) in Minneapolis. Dr. Pham was born in Vietnam and was a refugee to Minnesota while he was still a baby. Historically, his healthcare work centered around refugee populations; however, when the opioid epidemic expanded and started affecting more patients at CUHCC, his expanded his role to include addiction treatment.

Curatorial Team: Jon Hallberg, MD; Maren Olson, MD, MPH, MEd; Jennie Magner- Parrisha Roane, MD; Tseganesh Selameab, MD; Ben Trappey, MD;  Anthony Williams, MD, MS

Production Team: Abdifatah Abdi, Elizabeth Crippen Allen, Daniel Bergin, Jonathan Camp, Julie Censullo, Peter Chey, Carrie Clark, Jack Davis, Alyssa Franklin Fuller, Adam Geiger, Anne Guttridge, Laura Hammerbeck, Ted Hinck, Jacob Kelso, Slade Kemmet, Jim Kron, Ben Malley, Eric Pagel, Jennilee Park, Michael Phillips, Brittany Shrimpton, Scott Trotman

These personal reflections are a part of Art + Medicine: Speaking of Race, a one-hour special funded by the Center for the Art of Medicine at the University of Minnesota Medical School.

They are presented online by Racism Unveiled, TPT's digital storytelling project funded by grants from the Otto Bremer Trust, HealthPartners and the Saint Paul & Minnesota Foundation.