Artwork by medical illustrator, Chidiebere Ibe
You can find him at: https://www.instagram.com/ebereillustrate/?hl=en
Back in December, I was a viewing a medical student on TikTok who had asked a simple question: "Have you ever seen any kind of medical art or medical representation that was of a person of color?" He posted the above medical artwork (a profile of a pregnant woman and the fetus inside with beautiful dark brown skin). My mind began to meander with questions. A conversation with myself followed, which led to a surprising realization that didn't have anything to do with the artwork (and also everything to do with it):
Q: Until now, I have never seen brown skin in medical art, in a physiology book, or on the knee replacement model in my OS' office last year. I have four kids so I've been to the doctor, a lot. I had books as a kid that I looked at and studied. Classes. Other than the photos from the diabolical Tuskegee Syphilis Study, I haven't seen medical images of people of color. Why?
A: Maybe it's because I live in Utah, and it's pretty much mostly white people. The art represents my community.
Q: Except...then I would have to assume that all these charts and models and such were made here, or made specifically for my community, and other communities have representation. Do they?
A: No. (source cited below)* Besides, there are people of color here. Lots.
Q: Are there just more white babies born in the U.S. than black babies? That doesn't seem plausible (nor is it a very good reason). But I don't actually know. I wonder, how many babies of color are born in the U.S. compared to white babies?
Enter: Google
Because I am the worst at coming up with succinct search phrases, I crudely type the phrase, "Percentage of black babies that were born in the U.S. in 2022" into the search bar. To my surprise, the first several search results included things like:
"How many out-of-wedlock births in the United States" and "Percent of black babies born out of wedlock"
In fact, I couldn't get the simple bar graph or set of stats I was looking for on the whole results page. These results were not answering my question, and made me wonder... I went back to my search bar, left everything the same except I deleted the word "black" and put in the word "white" and hit the enter button. The very first result was exactly what I was initially looking for: "Percentage of births by race/ethnicity". And the others that followed it were similar results. In fact, I went two pages in to see if there were any results about "out of wedlock babies." Nope. This led to more questions:
Q: Why did I get different search results?
A: Melissa, think of how many times in the last year especially that people have brought up "broken families" when referring to people of color. Even in conversations about social justice and #blacklivesmatter, more than once, people would bring this very topic up - using phrases about them (black lives) like: "a cultural thing" and "crime rates" and "drug usage" and "lack of family values". Almost in a, "This is how they choose to live." kind of way.
"They/them"... meaning black people. All of them. Generalized and unnuanced.
Q: Is that why Google gave me indirect results for black babies?
A: It's an algorithm. It's anticipating your direction based on others' searches. It doesn't think the question you're asking is the question you're asking.
Okay, this is my take: Google held up to me an objective, algorithmic mirror to the subjective and racist world in which I live. The search for white babies answered my question directly. And, much like some of my conversations about racism, the questions about black babies took an indirect approach.
One of the sneaky aspects of racism, is that as human beings we are inclined toward bias and comfort. As readily as we participate in racism, or any kind of "otherism" - we just don't see it. And when we are confronted with it, we resist. The brain doesn't want to go there. I mean, I never once noticed the skin color in all the years of going to the doctor, or in all my classes growing up. I'm not naïve enough to believe I was colorblind and neutral about it. My brain saw a representation of myself, so I was comfortable. Bias confirmed and accepted so fast I wasn't even conscious of it.
Stanford Social Psychologist Dr. Jennifer L. Eberhardt wrote an outstanding book about this:
Here I am, months after that experience, and I realize I didn't spend any more time with the issue of the medical art. As I write, I can see some of my initial bias in the process that I didn't notice before. When the topic presented itself, my first inclination was to look for a "logical" and benign explanation. After all, a common response to such topics is some people want to make everything about race. So my questions are built around finding out if it's possible that it's not racist that 95% of medical art is of a white person? While there's nothing wrong with answering that question, it's important to weigh both sides of the scale and challenge my potential bias if I am ever going to come to a just answer. Otherwise, I might be tempted to instead make up reasons to keep my state of comfort. I should have asked other questions:
Q: "In what ways could this be racist?"
A Well, one race is substantially represented, so this feels like a dumb question. But let's ask and answer it anyway with some follow up questions.
Q: "Does this kind of representation matter in health care?"
A: Well, you deliberately chose a woman OBGYN - so to you it obviously does.
Q: "What if I only ever saw artwork, models, and prosthetics of people of color at the Dr.'s office and in pamphlets and text books? What message could that send to me?"
A: I don't know, and I'm not capable of knowing at this point - but I'm certain, based on my reaction to the above illustration I would have noticed the skin color without someone having to point it out. Also, if I had a rash, and my doctor only had images of rashes on dark skin, I might wonder if I'm being diagnosed properly.
Q: If this issue meant something to a person of color, would I listen? Would I validate it, knowing that I am incapable of truly understanding what this means?
I really hope so.
My question to Google was unaddressed, and I was waylaid into a strawman search result. The shocking part of that moment was realizing Google isn't impartial. It is designed to perform as its users dictate.
Q: So, Why haven't we had medical art, models, and prosthetics representing people of color other than for infectious diseases?
A: Go ahead, answer it.
What I am learning, is that in order to keep myself in check, I must be willing to ask what feels like tedious questions. I want to refuse ANY scapegoat explanation (blame) which separates myself from the other, and the possibility of enacting change. Most importantly, I need to listen to someone who is experiencing it from the perspective I can't ever have. If I truly believe in personal responsibility and empowerment, than I am always beholden to my neighbor. In my life, I have come to know this truth: I am only as powerful and free and loved as my neighbor is.
For I am involved in mankind.
Therefore, send not to know
For whom the bell tolls,
It tolls for thee.
-John Donne
Tonight, I did the same searches as before and got better results. If Google can do it, so can we.
*A 2018 study of four anatomy textbooks frequently assigned at medical schools found that dark skin tones were greatly underrepresented, making up less than 5% of more than 4,000 images analyzed. The same study also found that, despite having higher mortality rates for six common types of cancer—breast, cervical, colon, lung, prostate, and skin—Black people appeared in fewer than a quarter of images depicting cancer. None of the cancer-specific images showed what the study deemed to be dark skin tones. (https://healthcity.bmc.org/policy-and-industry/creator-viral-black-fetus-medical-illustration-blends-art-and-activism, Jan. 2022)
