A clinical pharmacology lecturer at The University of the West Indies (UWI) is arguing that the novel coronavirus disease (COVID-19) outbreak in the Caribbean has highlighted societal biases in the regional health system.
As such, Dr Kenneth Connell is urging regional governments to take the opportunity to teach health care workers how to identify and divorce themselves from their implicit biases and how to deal with patients irrespective of race, colour, or creed.
“What I find most interesting is that there is institutional implicit bias where the health care delivery team — even when patients do make it to the health care system and do seek care — there is a bias against them. We like to think of ourselves as one big, happy multicultural or multiracial Caribbean, but are we really?” Dr Connell, chair of the Barbados National Drug Formulary Committee, said yesterday. He was one of several presenters at a digital Vice Chancellor’s Forum entitled ‘Race, Class, and COVID-19’ staged by The UWI.
“There is a significant institutional bias,” he insisted. “I would challenge anyone who postulates that there isn’t, even in our Caribbean region… let’s take for example a country like Trinidad, you have a large Indian population and you have a large black population… we are uncomfortable speaking about this ethnic divide as it enters the health system, but do we as doctors and practitioners, nurses, do we treat the Indo-Trinidadian any different from the black Trinidadian? Do we even want to know if we do so, and how are we measuring it and if there is a difference in the way they are treated [and] what policies can be put in place to address this?” he asked.
“I will use myself as an example. Here in Barbados I constantly have to check on myself in interacting with certain classes of patients to make sure that my implicit bias does not influence their care,” he stated.
According to Dr Connell, COVID-19, which has unclothed the race, class, and health disparities which exist the world over, offers regional governments the opportunity to implement change.
“Now is the time for us as academics and professionals to agitate with a call to action and not just for more talk and more policies but implementing change,” Connell stated, adding that “in a post-COVID-19 environment one would hope that Caribbean governments will clearly articulate how they plan to address discrimination in health care, whether it’s class or race, because COVID-19 would have unearthed or magnified this”.
He also said while scientists and clinicians will find the new details being unearthed daily about the virus exciting, there was also an element of fear.
“There is a significant knowledge gap in two communities; there is a knowledge gap in the health care provider community [as] we don’t quite understand this novel virus. We may sound as if we know a lot about it, but we actually don’t. We don’t know a lot about exactly how it destroys the host. We don’t know a lot about its immunity, we are unsure about some of the drugs used to treat it. If you look at a lot of these clinical trials, a lot of the drugs have been used in treating other diseases and we hope that they will transfer their benefit to COVID-19, but we don’t have sufficient evidence,” Dr Connell said.
“There is also a knowledge gap in the population of patients and communities. One of my colleagues was approached by a patient who thought because she was diabetic she was at an increased risk of contracting the disease, which is not true. She is at an increased risk of having an adverse outcome, but just by virtue of having diabetes doesn’t increase her risk of contracting the disease,” he pointed out while calling for the use of simple wording to communicate health messages.