Divided: Read an Extract

05 April 2023

In the wake of the Covid-19 pandemic, we are all too aware of the urgent health inequalities that plague our world. But these inequalities have always been urgent: modern medicine has a colonial and racist history.

Here, in an essential and searingly truthful account, Annabel Sowemimo unravels the colonial roots of modern medicine. Tackling systemic racism, hidden histories and healthcare myths, Sowemimo recounts her own experiences as a doctor, patient and activist.

Divided exposes the racial biases of medicine that affect our everyday lives and provides an illuminating – and incredibly necessary – insight into how our world works, and who it works for.

This book will reshape how we see health and medicine – forever.

Follow Annabel Sowemimo on Twitter @SoSowemimo and on Instagram @soafrodiziac.

Read an opening extract from Divided below. Get your copy here

At no point in my medical education – nearly a decade of university, three degrees and countless hours spent on the wards – did anyone mention how the legacies of colonialism and racism affect my decisions as a doctor.

Shortly after completing my master’s (at arguably one of the world’s best public health schools, the London School of Hygiene and Tropical Medicine), I became disillusioned with how healthcare is taught and discussed. I’d spent a year studying sexual and reproductive health, particularly that of countries in the Global South, and I felt that there were gaping holes in many of our discussions. It was the same feeling that I had felt in my undergraduate medical education. I would sit in lectures and listen to senior doctors disparagingly make sweeping generalisations about why some Black people were at risk of high blood pressure and how these patients often did not take their medication. We never discussed the tension between majority white, middle-class doctors and racially minoritised patients. We never discussed how our health institutions have been shaped by imperialism. Nobody challenged these narratives. No one was given the space to do so. The system was heavily weighted in favour of a few. Medicine and healthcare is taught the way it is practiced. Only a few bodies have ever historically mattered: usually those of white, male, able-bodied and heterosexual people.

But I wanted to challenge this status quo, to rethink who the true experts may be. As a doctor, I knew that I garnered respect that many others did not, so I founded Decolonising Contraception Collective in 2018, a not-for-profit company with the aim of creating spaces for those working across sexual and reproductive health to discuss health inequalities among marginalised communities. Our mission was to create a not-for-profit company for those working across sexual and reproductive health to discuss health inequalities among marginalised communities and how race affects those accessing care. We dived into the history of our institutions, looked at the mistrust between providers and patients, and how race played out in healthcare. For some, it was quite emotional – we hadn’t been able to share our experiences and feelings like this before. As our events became successful, I began receiving messages from young Black women, who wrote that they had never heard people speak about how racism shaped their experiences of healthcare. I knew our work was important and I knew it was helping people, but every now and then I would speak to a medical colleague, and they would say something demeaning. My work was considered a ‘little project’. Colleagues told me it was ‘edgy’ and not ‘academically rigorous’. It was clear that this work wasn’t a priority to them – and, in some people’s minds, it was even a waste of time. As frustrating as this was, I did not care as long as we continued to help our communities and played some role in improving the sexual and reproductive health landscape.

And then, Covid-19 hit. As we entered the first months of lockdown in 2020, we witnessed these issues – of racism, colonialism and mistrust – becoming more vitally significant than ever. I had been writing for gal-dem for a few years, and, in the throes of lockdown, I felt it was the right time to begin a regular column on decolonising healthcare. In my first column, I wrote of my experience of encountering a young woman who needed emergency dialysis. Due to her fears about deportation, she hadn’t sought medical help until she had kidney failure. The article resonated with many – I received direct messages from people sharing their experiences of similar issues. Not everyone was complimentary – a few people suggested I was being overly critical of the medical profession – but it was the messages from young people, particularly medical students who would be shaping the next generation of healthcare providers, that had the most impact on me. My inbox flooded with messages from students across the UK, asking how they might spark similar conversations around the role that colonialism and race played within health at their medical school or if I wouldn’t mind speaking at an event. I tried to respond to as many students as possible but I simply didn’t have the time. And I realised I had far more to say than one conversation or lecture would allow.

I needed to start at the beginning and create something that untangled exactly how and why we have such profound health inequalities. We needed to look at our society and tackle the huge structural shifts that are required if we are truly going to see significant change. Despite the concerns I had of placing myself further in the public eye, I realised that I simply had to write this book. We urgently need to address the colonial history of healthcare and how it continues to perpetuate health inequalities. This is long overdue. Over the last couple of years, Covid-19 has brought most of the world to a grinding halt, and we all, now, have to acknowledge the role that healthcare institutions have in determining how we live our lives, and the real power that medical professionals yield. We can no longer deny that health inequalities and uneven power relations exist. This is most apparent in the poorest areas of the world. Black communities globally have been disproportionately affected by Covid-19 and have disproportionately died of the virus. Poorer countries have failed to secure adequate Covid-19 vaccinations. We must start to question precisely why this is the case. We need to make sense of the health inequalities we see. We need to address the racial inequalities in medicine. Only then can we hope to build a system that is more equitable for everyone.

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