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Medical student Malone Mukwende, 20: "If you have black lips, they don't look blue"
Photo:
Private
"And how would that look on darker skin?"
Malone Mukwende asked this question countless times in class.
The 20-year-old is studying at St George's, the University of London's medical school.
He recently completed his sophomore year.
Mukwende wants to become a doctor, "save lives," as he says.
But already in his first teaching unit he noticed that his lecturers only explained symptoms of illness on white skin and that there were no examples of other skin colors in his specialist books.
"A rash, bruise, or blue lips, these can be important indicators of serious illness," says Malone.
"But if you have black lips, they don't look blue. And spots or rashes show up differently."
Much of the world's population has no white skin.
However, much of the medical textbooks refer solely to fair-skinned people.
"In the worst case, people with different skin colors are treated incorrectly," says Malone Mukwende.
"A misdiagnosis can be fatal."
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In their training, many doctors only learn how diseases show up on white skin.
This can lead to serious misdiagnoses at People of Color
Photo:
Joe Raedle / Getty Images
There are some specialist publications that now specifically deal with symptoms of illness on different skin colors.
But Mukwende says he doesn't think "they have the recognition they deserve. They have been largely ignored."
He decided to do something himself.
With a scholarship from his university, he began collecting pictures and signs of illness last year.
Then he co-wrote Mind the Gap: A Handbook of Clinical Signs in Black and Brown Skin with two co-authors.
The title of the manual refers to warning signs on the London Underground.
They remind passengers of the gap between the platform and the train.
Anyone who falls in there can be seriously injured.
"And if we don't become aware of gaps in our knowledge, people all over the world will continue to be misdiagnosed," says Mukwende.
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Mukwende put his manual online free of charge
Photo:
Malone Mukwende
The student put his manual online free of charge.
It has been accessed ten thousand times in more than 100 countries.
To this end, he developed a website that doctors and doctors in training can use to upload and share photos.
Countless submissions have already been received.
Many of the images are currently under review.
Malone Mukwende and his team do all of the work alongside the university.
"The goal is to have a global database that is constantly updated and becomes an important resource in medical institutions around the world," says Mukwende.
"In this way we can all bring about change together."
He gives the Zoom interview between two online college courses from his bedroom.
However, nothing of this can be seen, as the background image he has chosen the Golden Gate Bridge in the Bay of San Francisco.
SPIEGEL:
Mr. Mukwende, which symptoms of illness are most often overlooked in People of Color?
Malone Mukwende:
This definitely includes all types of rashes.
On white skin, rashes and inflammations usually show up in noticeable red tones.
Depending on how light or dark your own skin tone is, the more the red changes - and the less it is often seen.
SPIEGEL:
How dangerous is it for patients if doctors fail to discover such signs?
Mukwende:
A misdiagnosis can be fatal.
For example, Kawasaki syndrome, an inflammatory disease that occurs mainly in young children.
In addition to symptoms such as a high fever, cough and runny nose, it manifests itself primarily in a rash similar to measles.
This rash looks very different on dark skin than it does on white.
If a doctor does not notice this, the treatment is delayed and this can endanger the patient.
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The sample picture from Mukwende shows how different the rash of Kawasaki syndrome looks on dark and white skin
Photo:
Malone Mukwende
SPIEGEL:
Some of the sample pictures in your book also show swellings or warts on dark skin.
They don't look that much different than on white skin.
Why did you take these photos anyway?
Mukwende:
It doesn't always have to look different.
Even if a swelling on a black arm can easily be recognized as a swelling, the specialist literature rarely shows an arm with a swelling that is not white.
The white skin is the standard.
We will not change this standard if we only show what is very different from it.
It should be normal to see a swollen black arm.
No more doctor should have to say, oh, but I didn't know what that looks like with dark skin.
SPIEGEL:
Is there anything that surprised you while researching your medical manual?
Mukwende:
I was shocked that when I had conversations with medical students in African countries, I kept hearing that they too had no specialist literature on symptoms on black skin.
Although they know from practice how to recognize signs of malaria, for example, they have nowhere to look up.
Textbooks that relate almost entirely to white skin are also used in Africa.
It doesn't make sense for the students, and of course neither does the patients.
It is the legacy of colonialism that lives on in teaching.
"I was shocked that in conversations with medical students in African countries I kept hearing that they too had no specialist literature on symptoms on black skin."
Malone Mukwende
SPIEGEL:
What do you think, why racism has been ignored in medicine for so long?
Mukwende:
Many have probably recognized that this is a problem.
In medicine and science, however, politics is preferred to be hidden.
That is why such one-sided textbooks may be ignored.
Of course, that cannot be a solution.
We have to deal with this and try to take action to better serve future patients.
I hope some of the doctors in Africa will share their knowledge and what they see every day in our database.
SPIEGEL:
The coronavirus pandemic has affected a disproportionately large number of blacks in the United States, for example - the cause is racism.
You grew up in London.
Have you experienced racism?
Mukwende: Personally,
I've often seen racism, but I don't want to talk about it.
The first idea for my manual came to me many years ago when I kept hearing bad experiences with the healthcare system in the black community.
At the time, however, I thought that these might be isolated cases.
At university, my view of it changed.
SPIEGEL:
Structural racism has also come into the public eye in the wake of the "Black Lives Matter" protests.
Do you think your book received just as much attention last year?
Mukwende:
I think the manual would have been well received regardless of Corona and the "Black Lives Matter" movement.
Simply because it affects many people in everyday medical practice.
Doctors want to save lives and for that they need knowledge.
However, this year made many people aware of the existing inequalities.
On a social level, that certainly helped to gain understanding and awareness of why my work is necessary.
In order to solve a problem, one must first acknowledge that there is a problem at all.
And often people don't want that.
Now society's view is sharpened and hopefully that will help change the system.
SPIEGEL:
Under one of your Twitter posts about the publication of "Mind the Gap" there are many comments from people who describe how they were misdiagnosed because of the color of their skin.
Including mothers who were accused of mistreating their babies because a special kind of birthmark looked like bruises on their children's darker skin.
Mukwende:
It's unbelievable what People of Color can be confronted with and how many stories I've heard about it since it was published.
Of course, doctors make mistakes every now and then, but all these stories show that some things cannot be dismissed as individual cases - just as I used to think.
My impression is that it helps people on a personal level to share and realize that they are not alone.
It makes a difference if it's a structural problem that can be addressed.
SPIEGEL:
What kind of feedback have you received from doctors?
Mukwende:
Many doctors and students from all over the world
contacted
me and were very interested.
The manual had already helped some with a diagnosis.
That makes me proud.
The idea that only one person could live longer because of this book is an absolute incentive for me to continue.
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