​Dr. Mala Joneja is an Associate Professor and the Division Chair for the Rheumatology Division at Queen’s University. She is also the Diversity and Equity Director at Queen’s, so we thought it would be a fitting and unique opportunity to interview and hear from her for this special issue of Queen’s Medical Review. We learned more about what is going on behind the scenes to address issues of diversity, equity, and inclusion at Queen’s, as well as how Dr. Joneja thinks medical learners can provide allyship to Black students, Indigenous students, and people of colour.

Moe Kohli

​When the repeated, systemic and painful injustices against the Black community came into the limelight this past spring, it was not only police brutality that was revealed. Inequities were discovered within various facets of life, medicine included. Many were inspired to reflect on their own biases and brainstorm the actions they could take within their own lives to demonstrate allyship. Simultaneously, however, groups of individuals wanting to change the system emerged. In our QMed community, one such group formed and took action. 

​On July 1st, 2020 the Aesculapian Society's "Report and Demands to the School of Medicine Admission Committee" was released. Highlighting inequities in the medical school admissions process and thoughtfully framing calls to action for increasing diversity in Queen's Medicine, the report synchronously informs and inspires readers alike. The document also includes steps that outline the implementation of each demand and a thought-provoking infographic elucidating diversity concerns in medical school admissions processes across Canada. Definitely a worthwhile read for medical students, faculty and administrators, both here at Queen's and abroad.

I had the pleasure of getting to know Aileen in her first year of university from being her Residence Life Don. Read more about Aileen’s journey as an entrepreneur and her ground-breaking startup that aims to change the hair care industry for Black women. 

Aileen is also a part of GreenHouse’s Innovators in Residence Program at St. Paul’s University College where she received the Social Impact Fund in July 2019. She has also been chosen as one of only 36 young entrepreneurs from across Canada to participate in the 2020 Next36 program, which is a Toronto-based incubator that supports entrepreneurs. 

Who are you and what do you do?
My name is Aileen Chinwe Agada and I’m currently an engineering student at the University of Waterloo. After working in a variety of companies in Canada and spending some time in Belgium; I decided to tackle new challenges in the hair care industry with my startup, BeBlended! As a founder, I attribute my success to my hard work, supportive network, and active Christian faith. When I’m not working on BeBlended or studying engineering things, you can find me kayaking, mentoring women within my community, and spending time with friends and family. ​

If you want to read more about Aileen and follow her journey with BeBlended, check out the links below!

Website: www.beblended.ca

Social media:

• Facebook: https://www.facebook.com/beblended.inc
• Instagram: @beblended.inc
• Twitter: @beblended_inc

​Articles:

• https://uwaterloo.ca/magazine/spring-2020/feature/waterloos-first-virtual-pitch-competition-awards-canadian
• https://uwaterloo.ca/stpauls/blog/post/blast-beblended
• https://badeobasa.com/blogs/blog/features-aileen-agada
• https://uwaterloo.ca/stpauls/blog/post/one-million
• https://uwaterloo.ca/stpauls/greenhouse/social-innovator-spotlights/engineering/addressing-hair-care-gap-black-women

 
Videos: https://www.youtube.com/watch?v=3NCzrQi6PFs
 
Podcasts:

• https://radiowaterloo.ca/tag/aileen-agada/
• https://podcasts.apple.com/gb/podcast/beblended-ft-aileen-agada/id1458679983?i=1000457331899

The primary argument for excluding race is the inherent association with systemic racism and oppression. When we slap a race/ethnicity label on a disease, is it because there are real differences in the prevalence of genetic variations among different races? Or is it the product of an upstream chain of events that create inequality in our society? I want to present this quote from an article published in the very prestigious journal The Lancet on May 2nd, 2020. The title of the article is Ethnicity and COVID-19: an urgent public health research priority. ​

I hope these examples highlight the importance of thinking about race with a critical lens moving forward. We can do unintentional damage by not thinking about race/ethnicity properly. If the reason race/ethnicity has historically been included can be traced back to systemic oppression, it should be excluded from medicine. At the same time, ignoring the unique circumstances where genetic differences are prevalent among specific ethnic groups also does our patients a disservice. 

There are many more examples of an inappropriate use of race in medicine published in this article by the NEJM for further reading.  ​

I was born in Canada, but I didn’t grow up here. I spent most of my formative years growing up and being educated in the Southern United States. Where I lived, 90%+ of the student body was white and 95%+ of the teachers were white. As a young, gay, Chinese-Canadian/American boy trying his best to fit in, I remember being pigeonholed into being a “model minority”. I was “smart”. I was “good at math” and “hard-working”. These were characterizations I was quick to accept, because it seemed to me to be a requisite to building connections and making friends at the time.

Over time, even though I was one of only a few people of colour in my schools, I began to make friends and find that sense of community that I yearned for after having been uprooted from what I knew as my home in Canada. But despite finding my place in this predominantly white community, I never felt like I belonged. I was often shamed for the lunches my mom would pack for me. Occasionally, my peers would yell racial epithets at me and gesture towards me with squinted and narrowed eyes. I was always reminded that my acceptance into these groups was precarious and conditional.

But regardless of my own experiences with racism and discrimination, what I didn’t realize then was that, despite everything, I was being enculturated with the racism of white supremacy. When I learned social studies in middle and high school, I was reading textbooks approved by a government made up predominantly of white people and written by white authors. My only view into the “other” was through events such as the Civil War in the 1860s, where white people are portrayed as the saviours of slaves. I was constantly surrounded by white people, and so I had internalized what was “socially acceptable” from their point of view.

When I began to transition from high school to university, I noticed that I felt more comfortable when I was surrounded by white people. I had begun to view people of colour, including other Asian and Chinese people, but especially Black and Indigenous people, with an innate heightened suspicion, based on how I saw my peers and my family interacting with them for years. Without me even knowing, white supremacy, anti-Black, and Indigenous racism had interwoven itself into every fibre of my being.

The indoctrination of white supremacist ideologies is insidious and instills within us a certain set of beliefs and stereotypes that becomes tied to our identities. We begin to turn a blind eye to the prison-industrial complex and the policing and mass incarceration of Black people because it doesn’t directly impact us. We make excuses for our own biases by saying we cannot be racist because we have lots of racialized friends and they are all “good people”. When we watch yet another news story of the police shooting someone, of which the majority have been Black and Indigenous peoples, we begin to make rationalizations as to why the police committed those acts “in the name of public safety” and “law and order”. We never think to take a step back to question the origin of our beliefs and we learn to simply accept the world for how it is. Especially for people of colour, we think we can’t be racist or discriminatory towards others because of our own identities and our own experiences with racism – only to not realize that we use those justifications as excuses to absolve ourselves of doing the deeper work of being truly anti-racist.

Medicine is a societal institution that likes to hold itself up as a progressive bastion of social change – at least to those inside its walls. But unfortunately, medicine is not immune to these tendencies – if anything, medicine serves as a perpetuator of the everyday stigmas and structural inequities that we so easily ignore. We learn that “being Black” is a risk factor, but the same clinicians we look up to don’t explain the why. They don’t explain how centuries of systemic discrimination, socioeconomic inequalities, and barriers to care contribute to the pathology we see. No one speaks about the history of experimentation on Black and Indigenous people as the foundations for our medical knowledge today. Social constructs are conflated with biological risk factors in teaching, in exams, and thus, in the way we approach the patients we see in our shadowing opportunities and clinical rotations.

When schools attempt to make efforts to teach from an equity and justice lens, these concepts are taught as theories only, without any connection made to medicine and our clinical work. We’ll spend one hour talking about social justice and being culturally sensitive and three hours talking about medicine and science, only for the medicine and science to make up 100% of our examinations. And so, when we encounter the topics related to the social determinants of health again, we tune ourselves out, since these topics won’t help us on our exams. The social history is only emphasized in specialties that perceive themselves to play a significant role in SDOH, such as family medicine and psychiatry, but certainly it should also play a significant role in other specialties too. When we, as medical learners, encounter microaggressions or outright racism in our clinical work, we’re taught to be quiet about it, lest we be marked as unprofessional for speaking out.

I’ll be the first to admit that I’m not perfect and that I still have lots of unlearning and learning to do. It’s taken years for me to work through my own biases regarding anti-Black and Indigenous racism, and it’s work that continues as I write this. When I feel myself getting defensive while having a conversation with someone or when I read or watch something, I have to take a step back and remember: this isn’t about me; this is an opportunity for me to learn and to continue to work on untangling the threads that have bound me and my thinking for so long.

As medical students and future medical professionals, we have a professional and moral obligation to do this work, to educate ourselves, and to understand the violence that the medical community and society writ large has and continues to inflict on BIPOC communities. Medical institutions continue to ask BIPOC to do the work of educating their peers as to their own experiences, to continue to pay an emotional labour tax without the guarantee of any change. While we need to continue to amplify BIPOC voices, we cannot expect BIPOC to constantly educate us. The act of asking them to relive their own traumas day in and day out in a display for our own education is an act of racial violence. We must stop labelling ourselves as being “progressive” simply because we are in medicine and recognize that simply by being in this field, we inherently have accumulated metric tons of societal privilege and a history of discrimination and racism.
​
As a profession entrusted with safeguarding the lives of others, we can no longer stay silent. The society we’ve lived in, some of us comfortably and some of us not, has regardless inflicted traumas on communities that stretch back generations. If we can sit back and accept that, it’s a sign that we have more work to do. Black Lives Matter.

“You have to tell the whole truth, the good and the bad, maybe some things that are uncomfortable for some people.”
- John Lewis (1940-2020)  

I have never sat down and documented my experiences as a Black woman. I think this is partially because I, like many Black women, have dedicated a lot of time assimilating and distancing myself from tropes that are associated with my Blackness. Still, at times these tropes become labels that I cannot avoid. This concept of tropes – the “angry Black woman”, the “sassy Black woman”, and even the “strong Black woman” have lingered in my mind as well as all my interactions subconsciously for years. I certainly do not want my story to become part of any stereotypes or to be implicated as the experience of other Black women – perhaps another reason I have not written much of this down. However, individual experiences are qualitative evidence – they are valid and I hope they can contribute to learning especially within my personal circles.
 
I named this piece Awakening because that is how my story begins and it is a recurring theme in snippets of my life so far. It begins the moment in my childhood where I realized being Black was different and to some people, “a big deal.”
 
I became awake to it.
 
I did not grow up initially thinking my skin colour was something of note. The people I loved and admired the most were Black. Some people were also Black or not Black – it was that simple. Just like any non-Black person does not grow up thinking their race is going to be this definitive aspect of their identity, I grew up the same. As a child, you are probably not thinking about how your race could impact your experience making friends, getting jobs, or even within public structures like health care and the criminal justice system. I was not awakened to this fact on one particular day of elementary school, but rather it was a compilation of what I saw in mass media and having other children comment on our differences. There were few Black characters or even Disney Princesses when I was young to dress up as in costumes. There has always been odd commentary when people try to dress up as characters that do not “look like them” - as if this really should matter. Suddenly, I was 7 years old and very aware of my Blackness.

​My story of awakening is also a story of untangling myself from my own anti-Blackness.
 
I would describe myself as outspoken, social, and keen. I have always been keen when it came to academics but also keen to get to know people deeply and earn their respect. Still, I have always had this feeling that at the forefront of who I am is my race. I constantly feel like in each of my initial interactions with people, that I am dismantling stereotypes they may come in with – this may be a pessimistic approach, but I have always found it to be the safest. In light of the recent Black Lives Matter protests, I have come to realize how much of how I viewed myself was tainted by internalized racism. Imagine growing up and consuming content all the time that is covertly or overtly anti-Black. The same anti-Black content that non-Black people subconsciously internalize is what most Black people are also exposed to and internalize. Sebene Selassie, meditation teacher and author, described it like a form of “double consciousness”, surviving in an anti-Black world but also being a Black individual. Outside of historical fiction, Black people were more often portrayed in relation to gang and gun violence, as troublemakers in school, or as sidekicks lacking depth. Films like Akeelah and the Bee where a young Black girl from a poor background eventually wins the National Spelling Bee were constant replays because frankly, there was not much else remotely positive that centered young Black girls. Even in elementary school, I remember constantly watching the Black kids be treated as “the bad kids” and experiencing this at times myself.  As discussed in Netflix’s Dear White People, you become scared of your own community and its potential for violence. Concurrently, you become scared of being perceived as violent or as the other negative tropes that are constantly shown in mass media. A survival tactic is to distance yourself so far from this so that you are non-threatening, can assimilate, and succeed – so I did this and have continued to do it until this point.
 
My story of awakening includes recognizing the need for the Black role model – the feeling was palpable for me when a Black role model was in a space.
 
Black role models have not been in short supply in my life. My parents are well-educated and self-employed business owners, my late maternal Grandfather was a well-loved physician and senator in Nigeria, I have physicians, engineers, nurses, teachers, and everything in between on both sides of my family. I think it showed throughout my life as I always knew and was often told how much potential I had and saw what I could achieve. Yet, there is something truly comical about being asked if I knew how to speak English while dressed in full professional attire at my Bed & Breakfast the morning of my Queen’s Medicine interview -  my Grandfather himself gave a full speech, in English, to a class of medicine graduates in Nigeria in 1989. My Grandmother was also an English teacher and eventually a principal. Microaggressions like this are painful because they reveal to how much (often white) people do not understand the state of knowledge in BIPOC communities around the world. The same ignorance is riddled throughout anti-immigrant rhetoric, despite Canada being built through settlers with the ideology of colonialism, and this hatred is rarely directed towards white immigrant populations.

Black role models however, were in short supply in all my public institutions. I had three Black teachers from Kindergarten to Grade 12 and I can name them: Mrs. Findlay, grade 7, Mr. Kouadio, grade 8, and Mrs. Brown, grade 12. Not coincidently, these teachers are also among the ones who I never felt doubted my abilities. Throughout school I often found my teachers described me as excelling in a way that seemed to surprise them – it was never clear to me why. I do not think my elementary school had a single Black teacher on staff the entire time I was there. I mention these teachers because yes, having Black teachers did make a difference to me. Seeing them always made me feel safer and my presence among my peers felt more normalized. It is challenging to describe the feeling of being a child or teenager, and just instantly feeling a bit more like you belong. This is the power of representation – a privilege that many do not recognize they have. Imagine yourself in school and never seeing a teacher that looked like you – not even in the hallways - not the most comfortable reality to picture. Yet, this is the norm for many Black children growing up in Canada. Even in the “cultural mosaic” that was Mississauga for me, the lack of explicitly Black representation or even Black celebration in our education was notable.
 
My story of awakening continued in higher education where I have discovered in short, the existence of ongoing institutional racism and the ignorance of students, faculty, and community members to this fact.
 
My undergraduate experience can be summarized by two main realizations. The first being that the war on drugs is really a war on poor and racialized communities as I have never seen more drugs so openly used as I have within “elite” university populations. As someone who grew up seeing drug use only portrayed in racialized communities and perhaps in elite corporate culture, its normality in everyday life was astounding. This alongside the copious amounts of binge-drinking that many of my peers attested to participating in since early in high school (I cannot relate). The second was that dating culture is certainly not the same experience for Black women. A lot of my interactions at outings consist of filtering out fetishization from genuine interest or having people suggest only Black men towards me because they assumed only those men would have an interest in me. 
 
I can say that although I attend a heavily white institution for medical school, Queen’s, I truly am surrounded by the most open-minded and inclusive friends – the majority of whom are BIPOC. It was a disheartening experience to learn within the first two months at Queen’s Medicine that from 1918 to 1965, my school had a formal ban on Black medical students[1]. A ban that was still technically in documentation until it was formally repealed in 2018 – the year I started at Queen’s. At one point it felt like everyone I knew had felt the need to send or tag me in articles about this – a constant reminder of the mistakes of the institution I would be attending for four years. I always ask myself, when Queen’s put this ban on Black medical students into effect, where was the public outrage? Where was the support for these students from all the other medical institutions in our country that are supposedly faultless? I am curious what is yet to be revealed about the racist practices of institutions in their history. In my eyes, it was obvious that the intergenerational effect of this was still occurring at Queen’s due to the blatant lack of Black medical students.
 
In March of this year, I was grateful to attend the historic inaugural meeting for the Black Medical Students’ Association of Canada in Toronto. Being in a room full of people in your field who look like you is a privilege that many Black medical students do not have every day. It was invigorating and rejuvenating of many things I believe about representation that I felt like I was starting to lose sight of. The family we have across Canada is undeniable and listening to their experiences, some being the only Black student in their class, saddened me. Through my work as Co-Director of Communications hereafter, I have further disentangled some of the internalized racism I had towards the knowledge and potential of Black students. Many believe Black students are not in medical school because they lack merit and for a time, I bought into this as well. However, I can confidently say now that meritocracy is an illusion that benefits those that life already favours with opportunities and who do not experience systemic oppression. We need our system to reward individuals with consideration of the various backgrounds, context, and circumstances that result in the advantages or disadvantages applicants may face.
 
Now let’s talk about silence.
 
Institutional racism also became evident to me when a Dermatology lecture could start with “I’ve pretty much for all of the slides given examples of Caucasian skin. […] once we move through today and move forwards into the months and hopefully years ahead, hopefully I’ll be able to come and I will bring you other skin types.” Spoiler: there has never been a session during our Dermatology block or any time in the upcoming years of medical school scheduled for lectures on Skin of Colour– this was an empty promise. A start like this would have gone unquestioned if not the for the vocal advocacy of myself, one of few Black students in our medical school. I hope in response to recent calls to allyship, others will feel comfortable advocating loudly alongside me to direct curricular change. It is also important for institutions to act on the saying, “nothing about us, without us.” The desire and act of not consulting Black stakeholders is rooted in white supremacy and superiority in our culture. Seeing Black people as the most knowledgeable makes people uncomfortable and it should not when you are talking about changes that impact the Black experience.
 
It is eye-opening to see classmates and future physicians who are normally vocal about their own life affairs and perhaps select issues like climate change or feminism, be completely silent when it comes to advocating for Black lives. It is in seeing people post and like content about #MedBikini who never did the same for the Black Lives Matter movement even though “professionalism” biases affect Black women in even greater magnitudes (many of whom would not feel comfortable sharing a bikini photo publicly out of these fears). This awakened me to a simple realization: receiving a medical school acceptance letter does not guarantee any individual is empathetic. In many ways, I have realized that people in medicine are among those with the largest egos. Many forget that medicine is a public service funded by the federal government, inherently political, and that these deceivingly “soft” social issues are actually blatant health concerns for the people you will treat. Furthermore, people in medicine are among those who may never have their ego checked again due to how society holds us on a pedestal. In June, Toronto Board of Health declared anti-Black racism a public health crisis and this sentiment has been shared among physicians and health organizations internationally. Yet, numerous medical students, the future of this profession, think that ignoring this issue is completely okay. Thank you to those who have acted otherwise and believe that participating in this movement and becoming an ally hereafter is part of an ethical obligation we have as a part of medicine. It is important to do so without projecting your own white guilt onto Black individuals who actually live with racism on a daily basis. All of this is not about white guilt, it’s about actions to centre on and change the experiences of Black people. My inbox is always open to those who are still finding their way and may need a hand.
 
My story of awakening is also a story of acceptance.
 
Acceptance of my community and all their potential despite others’ attempts to claim otherwise. And acceptance of myself, love for who I am, and all that I am capable of doing for the good fight.​

References:
​[1] https://healthsci.queensu.ca/blog/1918-ban-black-medical-students-addressing-our-past-discrimination-promote-diversity-future