For my first student interview, I spoke with Nana Amma Sekyere. She is a fellow second-year medical student at Central Michigan University College of Medicine (CMED). She actively promotes diversity at CMED by leading the Student Diversity Committee.
Archana Bharadwaj: Tell me about yourself.
Nana Amma Sekyere: I am originally from Ghana, West Africa. We moved to the United States when I was five, and we settled in Houston since my mom had brothers there. I grew up in a very diverse city. I had friends that were Indian, Hispanic/Latino, and Black. Even within the Black diaspora, there were so many different types of people, like my best friend who is from the Virgin Islands.
What did it mean for you to express your identity growing up?
NAS: I never even had to think about it because Houston is so diverse.
Did you feel like the diversity of your peers was reflected in your teachers?
NAS: In elementary school, I had teachers from all backgrounds, including White teachers, Black teachers, and Hispanic teachers. My middle school was predominantly Black and Hispanic, so my teachers were mostly Black and Hispanic. In my high school — which required testing to attend and focused on the medical field — we had teachers of all backgrounds.
Are there specific things that your teachers did to make your high school particularly inclusive or welcoming?
NAS: Because our professors came from different backgrounds, they were more understanding. We had certain days in the school year where we celebrated different cultures. There was an ‘International Day’ where students and teachers would wear traditional clothing representing their culture. On that day, you would see a person in Ankara fabric and another in a sari and everything in between.
How did these experiences compare to college?
NAS: It was a shock when I got to Baylor because it was predominantly White. I expected to see people from multiple races but hadn’t realized that diversity wasn’t the norm.
What did this mean for how you carried yourself or how you interacted with others?
NAS: I was conscious of how I represented all Black people when I was intermingling with other people, especially White people. In my American literature class, I was one of two Black girls. I was very mindful of how I answered questions and my work not only because I wanted to do a good job, but also because I felt like I was representing the whole race.
You were aware that they may have stereotypes, and you felt like it was your job to break those down.
How did that affect your ability to find mentors and make connections?
NAS: It was tough. I had a Biochemistry professor who was Asian. The commonality was that he was a believer in Christ. Baylor is a Baptist Christian University, so it wasn’t uncommon that faith was discussed. This professor would talk about it in class. Because of that commonality, I ended up connecting with him. However, I didn’t really have a mentor at Baylor.
How did your experiences at Baylor prepare you for coming to CMED?
NAS: It helped in the sense that I understood what it was like to be in the minority at an institution. The difference between Baylor and CMED is the location. Though Baylor University isn’t very diverse, Waco — the city Baylor is in — has a large Black population. When I lived in Waco, I was very involved in the community and had a church home there. I mentored little girls at that church, so I could take a break from Baylor and be immersed in the community.
You were able to create spaces for yourself and your identity, even if that wasn’t directly on campus.
NAS: Exactly. The difference between Baylor and CMED is that there is no escaping the demographics of CMED in the surrounding city, Mount Pleasant. The student population is actually a little more diverse than Mount Pleasant because we do have Muslim-Americans and a few Latino students.
What were your expectations going into CMED?
NAS: I was surprised that there weren’t as many Black students. I knew two Black girls that initially were going to come here but ended up going somewhere else for a variety of reasons. As far as living in this situation, since I was used to Baylor, it wasn’t too drastic of a change.
You already had a framework for navigating the lack of diversity, so you didn’t have to start from scratch.
What is one thing that surprised you about diversity at CMED beyond a lack of diversity in the student body?
NAS: I think the lack of diverse faculty. Even if you look at gender, most of our teachers are male. It would be nice to see more representation in faculty as well. In a specialty panel that was held during our last quality improvement week, there was diversity of specialties, and it was great to hear from all these different fields. But there was not a single minority among that group. The moderator asked them about dealing with bias; I felt like that moment depicted why diversity is necessary. Not even one of the White males could comment because they don’t go through biases. Two of the women spoke about experiences due to gender discrimination.
I am a Black female, so I experience things at a whole other level. I don’t think the lack of representation of minorities on the panel is due to lack of diverse providers around here, as I’ve worked with multiple diverse providers in the community. Lack of diversity amongst the faculty and leadership leave students like me without guidance in certain areas, like how to navigate bias.
AB: Although this panel was designed to highlight diversity in specialities, there was a major missed opportunity to highlight the racial, ethnic, and cultural diversity present within medicine. Therefore, in creating panels, even if personal diversity is not the primary focus, representation of various viewpoints by necessity requires more active, conscious inclusion of people of color.
What are some ways that you experience bias now?
NAS: I haven’t experienced anything overt where someone has said anything to me. I had a back and forth with another student where the student said two CMED professors didn’t have U.S. degrees because they weren’t born in the United States, but I knew that one of them had a U.S. degree.
The fact that the other student assumed two minority professors with accents couldn’t possibly have U.S. degrees is deeply problematic.
NAS: Agreed. I knew one of the professor’s stories because she had told me about her training in the United States. So, I pulled her faculty profile up online and showed it to the student. It clearly showed that the professor had a degree and post-doctoral fellowship from U.S. universities. Upon reading the professor’s profile, the student then felt like I was mad at her; but, this has nothing to do with anger. When I showed her the evidence, she said that they must have updated it because it wasn’t there when she looked. That didn’t make sense, because this professor has been working here for two years.
AB: It seems that the underlying problem in this situation is that the student’s statement demonstrated racial bias. When provided with information that refuted her bias, she disregarded it and wrote it off as a problem with the website update. To make matters worse, she made it personal and suggested that the corrective feedback came from a place of anger. The way people respond to feedback about their bias is important because these conversations provide an opportunity for growth when received openly but can also be a breeding ground for frustration when responded to dismissively.
What are some ways you think bias plays into the way we are taught or expected to provide care?
NAS: We are trained under race-based medicine. You get a question stem, and it says that the patient is Black. Then, immediately you are supposed to think of diseases like sarcoidosis. We are taught that race acts like a buzzword. We have a classmate whose mother has sarcoidosis, but she isn’t Black and was misdiagnosed for years because physicians thought she didn’t fit the “classic” racial presentation. Race acts as an anchoring bias, which can be very detrimental to patient care.
What was your impetus for joining the diversity committee?
NAS: Diversity in all spaces is important. My job as a multicultural coordinator and member of the diversity committee is to bring attention to minority experiences and create understanding of different cultures. For example, during Asian-American Heritage Month, we played a game of ‘Never Have I Ever’ with a panel of Asian-American students. During this panel, people shared microaggressions and other experiences. After the panel, classmates that came said things like “I didn’t know that” with a tone of empathy. Students who came left with greater understanding of others.
This is also relevant for medicine, too. In Ghanaian culture, Western medicine is a last resort. People will try home remedies before visiting a doctor. For classmates that aren’t from these cultures, it would be helpful for them to gain an awareness of how different patients will approach medicine.
What do you feel like have been the biggest challenges with the diversity committee?
NAS: Involvement. The M2 class has five people involved, but I think it would be nice to have had at least ten people. The M1 class has a little more involvement with six people. The diversity committee tries to put on a lot of events, and these members are involved with a lot of other things on campus. The other part is that there isn’t a lot of interest in events that we do, and this has been discouraging.
How would you describe the CMED campus culture around diversity?
NAS: It’s hard for me to do that because I tend to associate with people who are like-minded and open to new perspectives. So, this is what I see on a regular basis. I can’t comment on people who aren’t as open-minded because I don’t interact with them.
AB: You make a good point. A lot of the conversations I have about my identity are with other students of color or clear allies, so you create communities of like-minded people. It can be hard to break out of these groups and build buy-in, which is needed to create culture change.
What makes a good ally beyond being an ally?
NAS: You must adopt a posture of humility: not only being open and ready to learn from other perspectives, but also recognizing you have things to learn. You must be okay with being corrected. In going over a patient case who was described as Latino, a friend assumed the patient was from Mexico. I stopped and said that the case didn’t specify that the patient was from Mexico. My friend countered a couple times, insisting it had. We scrolled to an earlier page to find the case had not specified an ethnicity in addition to Latino. Unlike the first student who insisted the professor’s profile had been updated, this friend acknowledged their assumption. Being able to correct someone and know that they won’t storm off or say that I am crazy is important when it comes to making a good ally.
Thank you for taking the time to speak with me today!
NAS: You’re welcome!
After my conversation with Nanna Amma, it’s clear that openness is key for dialogue surrounding cultural competence and creating safe spaces to explore one another’s identities. But I’m left with the following questions: How do we encourage openness in others or invite them to the table in these conversations? How do we open the doors for having productive conversations with people that we do not think of as allies — the non-like-minded folks? How do we offer corrections to improve cultural competence in a way that promotes productive discussion over confrontation?
In this column, I will explore the unique challenges of training as a provider of color and offer solutions for improving diversity and inclusion in medicine. Through conversations with colleagues of color, including premedical students, medical students in training, and residents, I hope to create a community where we can learn from one another, cultivate allyhood, and find support in our professional journeys.