A wary, maybe even frightened, gaze falls on the doctor as she walks into the hospital room. She does not look the way the patient had imagined she would. Basically, the skills of the person responsible for providing care are being questioned. It may also show up in the form of remarks from superiors about their command of the local language, or, more seriously, patients adamantly refusing treatment. Medical staff are not spared from racial discrimination, which can come from patients, visitors or even colleagues. “When we hear about reports of racial discrimination in healthcare, our first thought is of patients. We’ve recently heard a lot about the ‘Mediterranean syndrome’, a bias with the belief that certain population groups exaggerate pain,” says Patrick Bodenmann, chief of the Department of Vulnerabilities and Social Medicine at Unisanté, and co-creator of a course on racism in medical practice. “Unfortunately, healthcare workers can also be victims of racism. For example, colleagues have had their status as physicians challenged simply because they are of a certain race,” the doctor adds, referring to a “taboo” around such discrimination. In an overburdened environment like a hospital, where emergencies are handled every day, staff are under pressure and do not have time to deal with administrative tasks. It is easy to let any disrespectful remarks or behaviour slide. But the long-term repercussions of this “everyday racism” are very real.
NO DATA, BUT REAL CONSEQUENCES
Kevin Dzi is a doctoral student at the Institute of Humanities in Medicine (IHM). Since 2022, he has been researching discrimination within the healthcare system, including racism experienced by medical workers, which includes nursing staff, healthcare assistants and physicians. Research in this area is still lacking in Switzerland. “The statistics we have on the subject mainly come from research in the United States and the United Kingdom. Practically no studies exist in Europe. For example, in Switzerland, data collection on race or ethnic background is not allowed, unlike in the United States. That makes research in the area more complicated,” says the PhD student. He abhors society’s stubborn belief that there is no racism in our countries. A survey of 800 US physicians shows that 59% of doctors have heard rude statements over the last five years about a character trait, mainly skin colour, gender, age or ethnic origin. Black and Asian American doctors are the most likely to say they have heard biased remarks from patients. Nurses, who are more in contact with patients, are on the front line (violence, insults, humiliation, sexual assault), followed by doctors (gender, nationality, skin colour).
Chantal Ngarambe Buffat arrived in Switzerland from the Democratic Republic of Congo in 1982 to study nursing at Lausanne University Hospital (CHUV). She remembers hearing offhand remarks from her superiors – “You look slow, but you always finish on time”. Her reports would be examined more carefully than those submitted by her colleagues. Once a patient commented, “she’s not like other black people”. “Our difference is visible,” the nurse adds. “We are therefore under closer scrutiny than others. We have to be more energetic to show that we deserve our place.” She now works in Unisanté’s Department of occupational and environmental health (DSTE).
These everyday aggressions can take a significant toll: loss of motivation, low self-esteem, lack of concentration, absenteeism, burnout, impact on the healthcare relationship. Yaotcha d’Almeida, psychologist and author of the book Impact des microagressions et de la discrimination raciale sur la santé mentale des personnes racisées1 , reminds us that race-based stress also has physical health consequences, in the form of cardiovascular disease, ulcers, hypertension and inflammatory diseases. “At the end of the day, we mustn’t forget that patients also pay a price,” Kevin Dzi states. “Poor concentration can have unfortunate repercussions on medical treatment.”
PROVIDING A HEALTHY WORKPLACE
However, still not enough complaints and grievances are lodged inside hospitals, despite the fact that racist situations exist, reports the recent master’s thesis by medical students2 from the Faculty of Biology and Medicine at the University of Lausanne. “Medical staff must not be afraid to come forward. The taboo is still strong because people fear losing their jobs or don’t want to be seen as a troublemaker,” Kevin Dzi says. Not to mention the fact that society holds to the belief that healthcare professionals should be resilient in the face of difficult situations. “Hospitals must offer neutral and anonymous reporting channels, where workers feel free and completely safe in signalling incidents,” the researcher says.