For our Labour Rights and Healthcare week of Vietnamese Advocacy Month in 2020, we reached out to UNAVSA alumni and community members who have are working in or studying various forms of healthcare—ranging from physical therapy, general medicine, pharmacy, and more—to ask them about their experiences of racial inequity in the field:
- Thu-Mai Nguyen, physical therapy
- David Le, optometry student
- Alan Trinh, pharmacy
- April Nguyen, pharmacy
Are healthcare providers sometimes the targets of bias or racism? Have you experienced this or observed this?
Thu-Mai: Yes, this can occur in different ways. Recently, we’ve seen healthcare providers of Asian descent be victim to racist attacks that blame Asians for the novel coronavirus that these same healthcare providers are working to combat. It’s still really common for female doctors to be assumed to not be a doctor and that the man in room must be the primary doctor. If you are small in stature or somewhat young looking, you are assumed to be inexperienced and not know what you’re doing.
Are certain groups of patients getting different care?
Alan: Definitely. Patients from different social-economical backgrounds do get different care, especially with minorities. In pharmacy, patients oftentimes don’t pick up certain medications due to the high co-pay of their medication making them not compliant to treatment for their chronic conditions. By being not adherent to their medications, these patients from the lower social-economical backgrounds will face future hospitalizations causing more economic problems for the patient and their family. Family problems can extend and affect the quality education of the children, access to nutritious food, and the ability to pay rent and necessities.
Thu-Mai: Certainly, and whether that’s useful or harmful depends on the context of the care being delivered. Individuals and their health are unique and should be catered to as such. However, this must include an acknowledgement of all determinants of health in order for the unique care of patients to be beneficial rather than biased. Ultimately, all patients deserve quality care; the differences need to be rooted in making it equitable and just.
How can healthcare providers and our community members address structural bias or implicit bias?
David: A better look into the education regarding cultural competency should help everyone understand that we should be mindful of others’ personal situations, traditions, and beliefs. Whether it’s how a person may appear on the outside, or how they speak along with their language proficiency, we have to understand and be respectful of that. There aren’t enough proper resources to educate people on this topic, and needs to be revisited to perhaps make insight on how these factors may skew outcomes in patient care.
Thu-Mai: In the long-term, it requires altering our culture to make it a collective goal as a team, an institution, and a community. An individual goal of eliminating your own bias is faulty and insufficient. Evidence shows that a team culture of collective improvement can lead to more sustainable practices because now it is everyone’s responsibility that we all do better. This creates an empowering context for us to correct each other on mistakes, remind each other of best practices, and seek further information and training (trainings on implicit bias, cultural competency/humility, patients’ rights and advocacy, etc). This team mentality includes our community members and patients because they are part of the team to keep healthcare workers accountable. An empowering context means that when we accept that we’re already ineffective as is, we start eagerly looking for the solutions rather than fearing being called out. It’s not about protecting our egos but about protecting our patients.
April: I became a pharmacist because I wanted to be an advocate for health. Healthcare providers can advocate against racism and discrimination to create an environment of compassionate care for the patients and communities we serve. It starts locally – we can engage our peers in open discussions about uplifting voices and how to become a more active ally to the Black community.
You do not need to be an expert to speak about and against injustice. These stories of advocacy and compassion for the community, and our commitment to be better allies and active participants in addressing structural bias, will help create a better tomorrow for the patients we serve.
Racism and discrimination are deeply ingrained in the social, political, and economic structures of our society. What do you think people can do, as workers in the healthcare field to help create change for this?
David: Directly acknowledge the faults in our system, as they have gone essentially unnoticed for the longest time. On a managerial side, reassess the methods used to create a more inclusive board of directors/executive team that may perhaps just be previously done to fill the minimum quota. Patient education is key, and we as healthcare providers should be able to convey to patients that they are being helped for with a standard of care, regardless of their individual status.
Thu-Mai: We need to go back and start at the education of these healthcare professionals. Racism and discrimination are not only present in the work environment, it’s all around society including our academic healthcare institutions. If we are training students to be healthcare professionals without providing the education needed to combat these harmful structures, how do we expect them to be able to learn change work once they are out on the field? Healthcare has too long been operating in a vacuum; separate from social, political, and economic determinants of health. We know now that health is inextricably tied to these social factors. It is the duty of our academic institutions to tackle their complicity in these structural forms of oppression and to prepare their students for dismantling it. In the workplace, we need institutional change as well. From health admin to the insurance system to care providers, we need to make our systems accountable for identifying and tackling where this is prevalent up and down the entire chain.
April: We are fighting public health crises on multiple fronts: in addition to COVID-19 and the current global pandemic, people of color and other marginalized groups continue to experience racism and discrimination on a variety of levels that lead to healthcare disparities. As one of the most accessible healthcare providers, pharmacists can play a role in changing the face of healthcare to break down barriers to care that exist in today’s society. As a profession, we advocate for health equity in marginalized communities. We need to engage in intentional dialogue and action to keep each other accountable as we challenge all forms of racism.