Stay Out

In the run up to the recent Black Lives Matter protests, I was, as a doctor, concerned about whether mass protests were the right thing to do. We know that mass gatherings with lots of shouting invariably lead to localised outbreaks, especially for a virus as contagious as Sars-CoV-2. Did I really want my patients and colleagues putting themselves at even more risk? Is this really in the interests of people of colour, especially when they are between two and four times more likely to die from the coronavirus?

My most immediate worry is my parents; they are precisely the right (or wrong) demographic to suffer badly from this virus. As my social life and travel shrank over the first weeks of lockdown, I urged them to take it seriously and stay at home. They reminded me that this is how they’ve always lived; the pandemic has not changed much for them. They have always been in lockdown.

They were among the pioneers who came, invited, to work in the NHS in the 1970s, only to be met with sustained interpersonal and institutional racism. Many health workers of colour were deliberately stationed in the under-resourced periphery, in towns without the diverse communities that would have made them feel welcome. Instead, they have had to endure all manner of verbal abuse and non-verbal humiliation from disenfranchised locals who have been taught to blame immigrants. The pragmatic solution of my parents’ generation was either to cluster in neighbourhoods with high numbers of diaspora families or, as my parents did, to build high walls to keep the nasties out.

Jordan Peele’s 2017 horror film, Get Out, a modern reimagining of Guess Who’s Coming to Dinner, brilliantly expresses the fear and awkwardness of a person of colour dealing with parochial white suburbia. But the unspoken message for me and my family from British society at large was ‘stay in’. When I was growing up, we did not leave the house except to go to school, work or the shops. We never went to pubs, barely ever ate at restaurants, and despite living close to three national parks, never visited any of them. The messaging within the household was clear: work hard, keep your head down, and don’t ever say anything controversial.

This is not to say that the country my parents grew up in is any less racist than Britain: India’s caste system has cruelly enforced social distancing for millennia. One of the low-status castes in South India, where my mother grew up, are the Paraiyar (anglicised as ‘Pariah’). Parai is a Tamil word for a kind of drum; the Paraiyar may have originally been a community of drummers, called to play and sing at times of crisis, such as floods, wars or funerals. They were thought to have magical powers and made to live in separate hamlets, outside villages.

British colonisers interpreted the separateness of the Paraiyar differently, assuming them to be inferior caste slaves. The wealth generated on Indian farms during the British Raj depended in large part on unfree Pariah labour, and – along with Indian elites – the British systematically hid this form of slavery from public scrutiny. Ever since, Pariahs (now known as ‘Dalits’) have been relegated to the bottom rungs of social life in India, still seen as untouchable outcastes. Between 15 and 20 per cent of Indians are Dalits; about the same proportion of Americans are of African ancestry.

The world over, people of colour are so used to racism that many of us – including me – tolerate it without getting vocal. It often doesn’t seem worth the trouble. But there is evidence that speaking out about racism has medical benefits. In 1987, Nancy Krieger – now a professor of social epidemiology at Harvard – conducted a study of Black and white women in Alameda County, California, which suggested that being treated unfairly on the basis of race raises your blood pressure significantly. The damage can be reduced, however, simply by speaking out about racism; Krieger found that Black women who ‘usually accepted and kept quiet about unfair treatment were 4.4 times more likely to report hypertension than women who said they took action and talked to others’.

This time last year I was using poetry to teach medical students ‘reflective practice’ through the medium of poetry. I asked them to analyse a sonnet by the Harlem Renaissance poet Claude McKay, the first part of ‘Through Agony’, which describes a master-slave relationship. The octave details the dehumanising effects of the white master taking advantage of the Black speaker. But then comes the volta (or turn), and by the end of the sestet the speaker has (whether materially or symbolically, we are not sure) triumphed and reclaimed their freedom.

This year the module has been cancelled because of the pandemic. My students’ generation make up a large proportion of those who are taking to the streets in cities across the world, wearing masks and sharing hand sanitiser. It feels like we have reached a turning point. They can see, behind them, the myths they have been fed about how and why global inequalities that affect people differently according to skin colour came about. Yes, these protests will make outbreaks worse, but the movement will make the world better. Even as a doctor, the right way forward is now clear. Bang the drum. Bring down the house.