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Writer's pictureLayecha Fidahoussen

Decolonising the Healthcare System: An Interview with Annabel Sowemimo

Dr Annabel Sowemimo is a senior clinician in sexual and reproductive health, a part-time PhD student, founder of a charity Reproductive Justice Initiative (RJI), and author of Divided, a book on racism and medicine. I am a Cognitive & Clinical Neuroscience on placement at King’s College from the University of Westminster. In the course of interviewing her for Black History Month, we touched upon her creative endeavours through activism, her work in the NHS, and decolonising the healthcare system.


She starts by saying, “I encourage others to explore, to read widely and have breadth, and not be scared of doing more than one thing!” 


Her passion for making impactful change has inspired her to learn more about the healthcare system and its flaws. 


“Activism is a term that people shy away from due to its association with strong political views”, she adds, additionally entailing that she wanted things to be different. Her going to medical school and being taught about the body as well as her academic training made her more aware of health inequalities, which deepened her motivation to start a grassroots organisation as well as form a collective of like-minded people who wanted to take action alongside her. 


“Look at the specific issue you are trying to address and see what is going to activate people”, she advises. “I started talking about racism and what I saw within my own social and reproductive health specialism and that's why I wanted to decolonise contraception”.


She initially started creating logos with an artist called Nicole Choe reflecting the topic of decolonising contraception. Together they created stickers and posts. She was surprised at how fast the stickers circulated when someone mentioned that they saw the stickers up in toilets in Edinburgh.


“I was like oh my God! It went all the way up to Scotland” 


She started getting invitations to panel discussions at SOAS (The School of Oriental and African Studies) and other events that had a big turnout. 


“For me, it was mostly a creative endeavour. I liked the science and the humanities and my way of subverting the narrative was to build art into that movement; my house is covered in protest art. I absolutely love it!”


In Divided, she explores the intersection of race and health and she explains the deep historical and present impacts of colonisation on healthcare. She has reported in her book that people thought she was being too overly critical of the medical profession therefore I asked her how she responded to this. 


She clarifies that she does not want to diminish the struggles of becoming a clinician but she emphasises clinicians’ positionality in a society where they are holding life in their hands so they don't face as much scrutiny and critique as they should. She continues, “I think that critique needs to come from within as well as outside because medicine is one of those things where it is quite difficult to understand the system unless you are a part of it. I’ve been both a patient and a clinician. Ultimately critique is vital if we’re going to improve as a society.” 


She continues, “Colonisation hasn’t ended in terms of the way that we structure our overall healthcare system: who gets medication, for example, or where our research is conducted. It's very much an ongoing process. All lives are not treated equally, which is why it's our duty to stand up for and combat. We need to question why we pull up more for some people than others, and how we allocate resources in our healthcare system. We need to keep reasserting what we think is right, to move closer to a better system.”


The wave of Black Lives Matter protests made people more aware of the oppressive system. This prompted me to ask her whether the protests have shed light on decolonising healthcare. Indeed, she saw within her work that people were more willing to listen and engage. However, she also noticed a pushback.  “Once people are more aware of oppressive systems,  then they change and adapt so they remain oppressive.” Difficult conversations were moved to surface-level actions, to light touch topics, because it's easy to say that they’ve done something. So even though black lives matter protests did shed light, we must be mindful about how language gets co-opted.” 


Following up on that question I asked her how we can have these difficult conversations especially when it comes to big institutions. 


“Some organisations (for example, the Royal Infirmary in Edinburgh) have done a detailed analysis of what the relationship has been with slavery and its legacy today. Only recently did we realise that slave owners were still being paid by UK taxpayers until 2015. A lot of people were not aware of that fact and it took investigative journalism and writing to bring and highlight that. Now there are still some exploitative relationships and things happening within our academic institutions, and we don’t know the full details because no one brings them up. In my book, I talk about the fact that UCL was hosting an intelligence conference for 4 years, about how the intellect is different along racial lines until a student paper brought that to the front. That is a present-day issue and was only revealed 6 years ago so for me it's very much about understanding also the hidden present that is happening so we can address it because the idea that it's just historic is not right. There are still things that are happening now and we need to know what they are, and we need to address them.”

 

COVID-19 significantly impacted health professions, especially the access to reproductive health services for marginalised communities. Annabel explained that a lot of sexual reproductive health services across the UK closed down or got temporarily suspended, limiting accessibility to contraception. This flagged issues regarding individuals struggling to handle their contraceptive needs, particularly people experiencing side effects or wanting to conceive. She raised human rights issues: “We shouldn’t be giving medical devices to people and then telling them we can't take them out when they want it removed. That’s not what they consented to. This was especially tough for people navigating that system when they have other challenges in their lives, like poor housing, difficulties making ends meet, or jobs getting more intense because of the pandemic.”


COVID was certainly a devastating period, however, she also acknowledged that there was a massive shift to improve their telemedicine services allowing for easier consultation and information accessibility. She notes that it isn't a substitute for complex issues but it prevents people from being “lost at sea”.


To conclude our insightful conversation, I asked Annabel what were three components of the NHS she wished to change.


Firstly, she recommends a truly holistic healthcare system that incorporates social determinants of health, allowing clinicians to work with professionals in housing and education. “This is not currently how the system works, we are very much working in silence.” Second, a need for flexible funding supporting a wider range of providers, and less privatisation which is causing more fragmentation due to outsourcing within the NHS. Lastly, opting for better working conditions. It is important to look at occupational health issues of the staff, from burnout to muscular-skeletal pain, and particularly issues affecting those who migrate to the UK. Addressing these issues is crucial to determining staff well-being and the overall effectiveness of the NHS.

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