By: Aiša Mrkulić , PharmD Candidate c/o 2022

             In fulfilling our vow to uphold the Oath of a Pharmacist, we must regard, “the welfare of humanity and relief of suffering” as our top priority. Voluntary are the promises which accompany this oath, promises with wellness at their forefront. ² It is not without reason that pharmacists are among America’s most-trusted healthcare professionals; Complimentary is their title as our nation’s most accessible healthcare providers. ³ Spotless white lab coats of prestige are not dealt lightly. Tarnished far more easily is a pharmacist’s privilege to serve; therefore, every threat to public health is to be met by pharmacist opposition. After all, it is pharmacists who are most likely to be the best advocates for patients. Public health crises are every pharmacists’ call to action and pharmacists-in-the-making need not be strangers to these events.

The American Pharmacists Association (APhA) and Academy for Student Pharmacists (ASP) collectively provide a platform for the advancement of the pharmacy profession and preparation of future generations of pharmacists. In their latest effort, APhA-ASP brought on board the APhA New Practitioner Network (NPN) to further diversify perspectives from which valuable dialogue would come. The first of a series of webinars unpacked systemic racism to reveal its true form. In the eyes of healthcare professionals across the nation, it was no less a public health emergency than COVID-19. A pandemic in its own right, one of our very own answered the call to shed much-needed light on its unraveling.

St John’s University College of Pharmacy and Health Science’s Vibhuti Arya, PharmD, MPH, Clinical Advisor for Policy, Resilience & Response at the New York City Department of Health and Mental Hygiene, served as keynote speaker of Rise Up: Addressing Systemic Racism: A Public Health Emergency. The goal of this webinar was to provide a safe space for engaging in open and honest conversation. Keith D. Mariciniak, BS Pharm, Senior Director of Student & New Practitioner Development at the APhA, helped to mediate the discussion. Attendees consisted of student pharmacists and practicing pharmacists. Both had the opportunity to ask questions in one of two ways, live during the webinar or prior to its start.

Prior to the much-awaited Q & A session, Dr. Arya set the tone with a 4-minute video of her creation. To start, the Oath of a Pharmacist filled the blank, black backdrop with its thin, white lettering. Vow after vow was presented one at a time. These crucial, initial 30-seconds served to captivate the audience. In the same fashion, systemic racism was then declared a public health emergency. Viewers were called to “rise up” against that which perpetuates health inequity. “From womb to tomb,” those belonging to the Black community are followed by racism. Dr. Arya’s message is a clear one; Those who do the work of a pharmacist possess the privilege required to accomplish real change for their patients. She invites viewers to look inward, so as to develop an awareness of their own implicit biases. These are, “unconscious racial stereotypes,” resulting from “personal and cultural experiences.” ⁴ Listeners are reassured that although mistakes will be made, learning is not possible in the absence of such shortcomings. As Dr. Arya stated, “Discomfort is where growth…happens.”  ⁵ Uncomfortable as it may seem, too many have been far more than uncomfortable for far too long! We must do the work, “challenge false narratives…have these honest conversations”. ⁵  In the words of Dr. Arya, “racism hurts everyone,” and in that of late American Minister and civil rights activist, Dr. Martin Luther King Jr, “injustice anywhere is a threat to justice everywhere.” ⁶ “I will consider the welfare of humanity and relief of human suffering my primary concerns,” comes and goes for the second time in 3 minutes, holding and making space for reflection and introspection into our own implicit biases. Could it be that these very biases are affecting the care patients of color are receiving? Of course! Recognition of this very fact is of the utmost importance if an opening for favorable change is to arise.  COVID-19 continued to paint a vivid  picture of how racism has contributed to health disparities. ⁵ In his letter to the New York Times Editor, President and Chief Executive of Montefiore Medicine, Philip O. Ozuah,, MD, PhD,  said  “I fought two plagues and only beat one…twin disasters disproportionately hurting minorities” in his reference to a brand-new strain of the corona virus and racism. ⁶  Only one is, “a virus as old as the country itself.” ⁸ Irrespective of the global pandemic, Black patients face higher rates of premature deaths. Black men are twice as likely than, “white men in New York City” to die before their time. ⁴ Dr. Mary T. Basett, MD, MPH, Commissioner of the New York City Department of Health and Mental Hygiene, rightfully points out that, “violence cannot account for all the lives cut short.” ⁴  Police brutality is very much a reality however,  Dr. Basset urges the medical community  to abandon the sidelines and assume the responsibility of dismantling a broken system, one which harms the health of patients.

             Doctors David A. Ansell, MD, MPH and Edwin K. McDonald, MD of the Department of Internal Medicine at Rush University Medical Center in Chicago, Illinois, explored the impact of racial stereotypes on patient care provided by physicians. As it turned out, these implicit biases plagued the decisions of MDs with even the best of intentions. ⁴  Implicit bias is the main driver of, “mistrust on the part of black patients.” ⁴Dr. Arya put it best when she voiced the following, “Baseline anxiety and stress are greater in people of color not due to genetics, but on account of their lived experiences.” ⁵ So why is it that Black patients prefer to be treated by providers who share their race? Their rightful mistrust of healthcare professionals is your answer. Black Americans should not be receiving less effective care than white Americans. Reform starts with those who provide the care. Changing our ways, mitigating the spread of a novel coronavirus required no less, “determination to change our behavior” than is needed to end “endemic racism and brutality.”  ⁸ It is important to note that systemic racism was not coined a public health emergency during the start of a new decade. Instead, it was first addressed over 6 years ago, when medical students across the country opposed, “racial profiling and police brutality” in the form of a, “coordinated protest branded #WhiteCoats4BlackLives.” ⁹ It was then that a fighter  group of individuals ventured to, “reframe the harms of racism as a public health crisis.”  ⁹ One after the other, city mayors were declaring synonymity between the two. Though Boston Mayor Marty Walsh is not alone, many more must follow his lead and acknowledge systemic racism as such. ¹⁰ The current call to action is louder than all those which came before. It is presently that history is in the making. A then fourth-year medical student by the name of Nicolas Barcelo left demonstrators with these final words, “The context in which our patients live contextualizes the type of care we need to provide.”  ⁹ What a group of medical students were able to kickstart can and should persist with involvement from the pharmacy community. There is no time like the present to dismantle racism in recognition of its, “threat to the health and wellbeing of people of color.” ¹⁰

Dr. Adam Martin, PharmD, founder of the Fit Pharmacist, and recipient of the Most Influential Pharmacist Award, echoed the sentiment of Dr. Nicolas Barcelo, MD and then some. He warned pharmacy professionals against evoking color blindness as an answer to systemic racism. According to Dr. Martin, doing so encourages, “a disregard [for] the complexities of racial issues that are [very much] real and alive in our world today.”  ¹²  The second danger releases professionals of their responsibility to disassemble internalized prejudices and rebuild. Not convinced? Conducting a quick google search for the Harvard Implicit Bias Test is likely to challenge that perspective.  ¹³ The Fit Pharmacist founder warns against the unintended belittlement of Black lived experiences. Moreover, he challenges his audience to instead demonstrate an appreciation for individualism. These prospective patients are to be, “accepted for who they are.” ¹² It cannot be fairly expected of them to embrace our care or otherwise adhere to it.

Dr. Arya would go further as to say, “Do not place blame on the individual patient for their health. Pertaining to social determinants of health, the narrative of personal responsibility is faulty.” To Dr. Arya’s point, even a zip code functions to maintain marginalization, indicative of, “socioeconomic factors…inherent to health and longevity”. 14 Race and income are among these social determinants of health. Geographic differences, “even if…just blocks or miles…” vary life expectancy. ¹²

“Remember, you can’t fix something you can’t see,” therefore, there exists no other option, but to see color. 12 I see no color is not the goal! To ignore color is to ignore race and effectively abolish our nation’s history of systemic racism. Dr. Martin left viewers with this final message, “If you turn a blind eye…you are not only doing the profession a disservice…you are doing a disservice to your patients, and if we can’t serve them to the reality that we all live in, what’s the point?” ¹²

Whiteness has afforded me privilege and with it comes greater opportunities than those available to my Black counterparts. At hand is the chance to be the change I hope to see in healthcare and beyond however, one cannot have a conversation about systemic racism without the perspectives of those directly affected. The following are the words kindly shared by our PharmD. Program’s Black community—thank you for lending your voices.

Adriana Hudson; PharmD. Candidate; Class of 2021

“Change cannot come about until everyone realizes that there is a problem. My people, Black people, have suffered at the hands of racial injustice for over 400 years. Systemic and institutionalized racism is still very prominent not just in the US, but all over the world. I think what is really concerning is the racism that exists in the medical field. Old myths and stereotypes are to blame for Black people receiving inadequate medical care. This is something that needs to change immediately. As healthcare professionals, it is our duty to protect our most vulnerable patients…. our Black patients. Please realize that now is not the time to be silent. To be silent is to be ignorant and complacent. Use your voice! Be loud! Speak up and out against racism. Educate yourselves on our history…maybe then you will come to understand why we are tired of fighting for our lives.”

Bria Pratt, PharmD. Candidate; Class of 2021

“I can only speak from my experience, yet my experience seems to interconnect with many others who look like me.  As a young black female who is on track to become a healthcare professional, I can see that people, particularly from minority communities, feel as though the healthcare system views them (us) as invaluable to society.  The scarcity of resources, inaccessibility to adequate healthcare, and costs are just some of the reasons why there is a disparity in this country. There is also the disconnect between patients, the distrust of providers, and lack of cultural competence that continues to be the plight of the medical field that needs to be changed whether it pertains to physicians, nurses, pharmacists, therapists, etc.  This is something that cannot be done alone; everyone needs to come together for the greater good of our patients because isn’t this what we signed up for?”

Tolulope Omisakin, PharmD. Candidate; Class of 2022

“When treating non-White patients, consciously remember that your unconscious bias leads you to make decisions that you wouldn’t otherwise make when treating a white patient. Racism is so rooted into everyday life that unless you reflect and purposefully challenge what you think you know, you will fall short as a healthcare provider to the population who may need it the most. Pharmacists have been hailed as the most trusted profession for several years. It is the role of Student Pharmacists to continue to push that narrative by being the protagonist for our patients, especially the ones of color.

Our profession is not without its own racial blemishes.  Experiencing racism is never an easy topic to speak about, but it is a necessary conversation especially for my fellow PharmD. candidates who refute the existence of it. Of all my experiences as a black girl within the Pharmacy profession, the biggest blow for me was when I was told that because people who look like me hold this degree, it cheapens its value. This comment and how it made me feel is something I have to carry with me while I continue my journey into the world of pharmacy. I urge readers to look into their own lives, correct your friends, bring awareness to your family. Never let that racist comment or action just slide because no one but you heard it. Hold them accountable and hold yourself accountable.” 

Jason Ifeanyi, PharmD. Candidate; Class of 2022

“Racism is not an issue that I normally talk about publicly, for it is such a sensitive and divisive issue. However, during fervent times like this, each voice and each story, can make a true difference in terms of raising awareness.

As aspiring pharmacists, arguably the most accessible healthcare providers, it is our duty to serve and advocate on behalf of our patients. Each patient must be treated based on their own unique needs and experiences, in order to have a fair chance. Part of protecting and advocating for patients includes taking a clear stance on implicit biases, and the harmful effects they have on POC.

As one of, if not, the only Black male in my graduating class, I am not without my own unique share of experiences. The first semester of my freshman year proved to be one of the most challenging experiences I have ever faced mentally. Being in classrooms where I couldn’t see a single student who looked like me was discouraging. Whenever I told people I was a pharmacy major, I was met with looks of shock and amazement. I began to doubt whether I was in the right place, and whether I belonged. I will never forget the one day where I came back to my dorm after class, and just sat there on my bed, and shed a few tears. After speaking with my parents, I was reminded of the innate qualities I have that got me here in the first place. It was at that moment where I decided to rely on my determination, work ethic, and self-motivation to overcome these challenges. I never looked back. From that point on, I have consistently been one of the top students of my graduating class and I have no doubt that I belong here.

So why mention such a personal story? I mention such a personal story because change doesn’t ensue simply from talking about the challenges we face. Change, much like success, begins with a mindset. If we are going to make any meaningful and sustainable change, we must carry with us a certain level of work ethic, determination and commitment. We ALL need to put the work in and spend time educating ourselves on social determinants of health and how they contribute to health disparities among different patient populations. We ALL need to be committed to looking within ourselves and challenging any implicit biases we, or those we surround ourselves with, may have. We ALL must be determined to lead by example, and more importantly, lead with empathy.”

Duchess Iregbulem, PharmD. Candidate; Class of 2022

“I know well the bitter taste of microaggressions. Coming from an all-white private high school, it was routine. A stare there, an insensitive comment here, and at the end of the day, if it could all be laughed off as a “joke” then it would be fine, right?

Wrong.

Yet, like all humans, I found ways to adapt and cope with my environment, to make the most of it. I still have wonderful memories from my high school as a testament to that.

But for some reason, the one place I never expected racism to appear was in the healthcare setting. I naively assumed, much like most people unconsciously do, that a place where science prevailed, and a patient’s well-being was paramount must be devoid of racism … right?

Again, Wrong.

As I sit in my seat, one of 5 black girls in my class of almost 200, the same stares kick in. The same comments. The same jokes. If this is the environment in which we are to groom the next generation of healthcare professionals, then how are we ensuring that we are better than the last?

We have been shown time and time again that this disease, racism, persists through those too blinded by their ignorance to detect its presence in their very beginning. Racism is like an invisible chain that wraps around the necks of those it oppresses. By not consciously recognizing where it strikes, we are allowing this disease to disproportionately target and kill the very same patients we claim to serve.

We all must be willing to lend our minds, voices and spirits to combat the thing that continues to not only tarnish our profession, but our people as a whole. If we are to build a healthier and more compassionate profession that can better serve our world, change must start from within.”

Robert Thompson-Eshun, PharmD. Candidate; Class of 2022

“For anyone that is pursuing a career in healthcare one of the greatest skills that I think is not talked about enough is having the ability to be self-aware. Having the self-awareness to understand that your life, knowledge, motivations, and desires are very different than most people you come in contact with. With this in mind in terms of treating non-white patients, the mindset that allows me to see if I am doing what I am supposed to be doing is to remember why I chose to go into pharmacy in the first place. One of the main reasons that I got into pharmacy is because I was seeing the effect that it had on the lives of my parents as well as many different people in the African American community. That led me on the pursuit to figure out the best ways to care for my family and community. With that being said when treating any patient, I always ask myself, “Did I give them the same level of care that I would have given to one of my parents or family members?” This mindset as well as remembering the pharmacist’s oath to help those that you serve need to be in your mind every time you help any patient that comes into contact with you.

I don’t recall any single moments where I experienced racism personally. But one thing that is in the back of mind is how underrepresented minorities are in the profession relative to their numbers in the general population. Even in everyday classes, it gets a little discouraging when you see relatively few people that look like you. Even though I try not to think about it too much I would be lying if I said that it did not have any effect on me. Instead of dwelling on the issue I now use this as a motivator to hopefully show future generations that if I can do it anyone can do it.”

             Not naming whiteness allows racism to continue to operate. Disparate realities, so unalike that there is no basis for comparison, are those lived by student pharmacists who differ only by the color of their skin. I thank the white contributors for joining this conversation. All of us have skin in this game, a sentiment appreciated by Natalia Loomis, PharmD. Candidate ’22, and Thomas Crowley, PharmD. Candidate ’23.       

Natalia Loomis, PharmD. Candidate; Class of 2022

“As someone who is privileged, I remember one of my first encounters with an act of ignorance that supports the inequity in which we still live. In high school, we’re sitting on the bus to go to soccer practice on an August afternoon. It is hot! It’s a Summer afternoon. A black friend of mine was putting on sunscreen. A white girl on the bus let out an ignorant remark along the lines of “Why are you putting on sunscreen? You’re black.” I watched my friend defend herself. She said to the offender that despite not seeing red on my skin, black people can still get sunburned. UV rays do not discriminate. As a culture we discriminate, but not the UV rays. I couldn’t believe my ears, but at the same time, I could. In moments like these, ignorance is so prominent. 

The fact that this is not common sense bothers me. The fact that there is systemic racism in all facets of our life, including the healthcare system, angers me. It disturbs me. Someone is more inclined to help a white person than a person of color for absolutely no reason aside from the color of their skin. I think when you become a healthcare professional, your goal should be to provide adequate healthcare across the board. No one is more or less deserving of treatment, especially based on the color of their skin. At the end of the day, it takes a lot of research to go back and fix all of our implicit  biases in the healthcare system however, it is up to us to do that work as healthcare professionals and remember that our duty applies to every patient we treat.

I am fortunate enough to have friends belonging to all walks of life. Among this diversity, I have witnessed the healthcare disparities that come with being a person of color. As someone who is not of color, I feel obligated to protect those who are. I recognize that my voice will only amplify theirs. Why are people willing to listen to my voice and not that of those who are going through it? This is another issue in and of itself. I firmly believe it to be our duty to stand with and fight with those whose voices have been muted for far too long.”

Thomas Crowley, PharmD. Candidate; Class of 2023

“I want future Pharmacists to keep in mind that many of the concerns and complaints of non-white patients are taken less seriously than those of white patients. We must make sure we provide all patients with the same level of respect and attention. As the most accessible healthcare professionals, we must make sure we provide the best care possible to every patient, regardless of race. That means taking the concerns of every patient seriously and aiming to provide the best counseling possible. It means keeping your implicit biases in check.  And it means not allowing discrimination in any healthcare setting to continue.

In my experience as a white male, I have not experienced discrimination directed towards myself in any healthcare setting. I have witnessed microaggressions toward non-white patients.  The example I can describe best is a pharmacist who was very irritable toward patients with limited English proficiency who are Hispanic or East Asian. The pharmacist was trying very hard to finish interactions with these customers. Yet, that same pharmacist would be very kind and understanding toward patients with limited English proficiency who are from a European country such as Italy, Greece, or Germany…even though in each case it was difficult to communicate with the patient.”

Not long after its call to rise up, the APhA spearheaded a campaign to address structural racism. It was on June 22nd, 2020, that the organization made the action-packed announcement. ¹⁵To date, a task force has been established and a joint statement published. The diverse group of APhA members is actively working to tackle the longstanding public health emergency, one which plagues, “every facet of our profession”. ¹⁵ The, “only organization representing all of pharmacy [APhA]” would officially lead the national initiative, standing against, “racism, discrimination, injustice and marginalization”.¹⁵ Professional development opportunities, advocacy, policy development and publications are just a few ways they will raise awareness. Under the APhA’s leadership, numerous national pharmacy organizations have joined these inclusive efforts. With the release of  an engaging joint statement on June 5th  came a social media campaign, marked by the hashtag PharmacistsFightingRacism. ¹⁵ Pertaining to this and future endeavors, Andrew Gentles, PharmD BCPS, AQ said, “To our communities, we are listening…but most importantly, we intend to take action.” ¹⁵

Dr. Gentles and his task force invite us all to email [email protected] with suggested actions the national pharmacy organization can take against racial injustices ¹³

Below are additional writings on systemic racism as it pertains to health inequity. All articles can be found on Medscape (with the exception of the first). Though not cited in the body of this work, these truly are worthy of our collective attention.

Tafadzwa Muguwe. A Dual Degree from Oxford. A Medical Degree from Harvard. Neither Protected Me From Racism. wbur website. https://www.wbur.org/cognoscenti/2020/06/18/racism-doctor-harvard-medicine-training-tafadzwa-muguwe. Published June 18, 2020. Accessed June 19, 2020.

Carol O’Donnell and Trish Roy. Black Americans Hospitalized for COVID-19 at Four Times the Rate of Whites, Medicare Data Shows. Medscape website. https://www.medscape.com/viewarticle/932778. Published June 23, 2020. Accessed June 25, 2020.

John White. Why Are Minority Populations More at Risk for Contracting and Dying From COVID-19? Medscape website. https://www.medscape.com/viewarticle/932325#vp_3. Published June 15, 2020. Accessed June 25, 2020. 

Dinah Miller. I Am Part of the Problem. Medscape website. https://www.medscape.com/viewarticle/932880. Published June 24, 2020. Accessed June 26, 2020.

Recognize that anti-black racism is a specific racism, observed across the board in all cultures of the world. Not all people of color experience equal levels of injustice. White folks and non-black people of color are invited to consider the words of indigenous Australian or Murri visual artist and women’s activist, Lilla Watson. When sifting through these resources, give thought to the following, “If you have come here to help me you are wasting your time, but if you have come because your liberation is bound up with mine, then let us work together.” Our liberation is bound together. Fight the good fight, but not as an act of charity. Rather, in the name of the collective.

Much thanks to Founding Director of the Academic Center for Equity and Inclusion, Dr. Manouchkathe Cassagnol, Pharm.D., BCPS, BCCP, FACC, CTTS, for making known the wise words of Watson.

Sources

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Published by Rho Chi Post