The Chronicle of Skin & Allergy, in partnership with the Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE), sponsored a short essay competition for Canadian dermatology residents in 2022.
This contest was open to any resident enrolled in a dermatology training program at a Canadian medical school, with enrolment confirmed by their Program Director.
Entrants submitted a 350- to 500-word composition reflecting on matters relating to inclusion, diversity, and equity.
Today in Derm.city we showcase the 2022 Grand Prize winner Dr. Samantha Bizimungu of Université de Montréal for her essay “Getting to the Root.”
Dr. Samantha Bizimungu is a second-year dermatology resident at Université de Montréal. With an extensive background in advocacy, she is passionate about working to eliminate disparities in healthcare.
“WHY DIDN’T YOU CONSULT EARLIER?” I asked my patient, while examining the large
hairless patches on her scalp.
“To be honest,” she replied, “I didn’t think a doctor could do anything about this.”
“Mm-hmm…” I said, glancing at her knowingly.
The patient in front of me was a Black woman. She suffered from progressive
hair loss along the temporal hairline, after years of wearing high-tension hairstyles.
It was a slam dunk diagnosis: traction alopecia.
Beneath the seemingly straightforward nature of this case, however, more complex
issues were at play. These spun through my head all morning as I assessed patients
in the dermatology clinic.
Traction alopecia affects an estimated one in three women of African descent.1 It
is often linked to hairstyling practices that are common among this demographic,
such as braiding, hair weaves, and the use of chemical relaxers.2 There is no cure for
this condition, and its progression can lead to irreversible hair loss.3
One might wonder: Why would an individual continue to wear such a hairstyle if
it is responsible for their hair loss? Unfortunately, the answer isn’t so simple. Hair is
seen as a sign of beauty and a source of self-esteem in many cultures. Western
beauty standards favour straight and wavy hair textures over the curly and coily ones
that occur naturally in people of African descent. Additionally, Black women often
feel the need to conform their appearance, including hairstyle, to fit in to the workplace
and avoid discrimination.4 Whether consciously or subconsciously, these pressures
lead many Black women to use damaging methods to achieve straighter hair.5
These women can then be reluctant to seek medical help if hair loss occurs.
American data shows that Black and Hispanic patients are less likely to receive outpatient
dermatological care than their White counterparts.6 Barriers to care include mistrust of the medical system and lack of knowledge of the dermatologist’s role in managing certain conditions.
As initiatives to represent diverse skin and hair types in educational resources become
more widespread, it is equally important to acknowledge the cultural practices, lifestyle habits, and deeper societal issues that contribute to these patients’ conditions.
Diversifying the dermatology workforce will also help to reduce health disparities.
Black patients report higher satisfaction when receiving race-concordant care, due to
factors such as shared experience, cultural sensitivity, and knowledge about skin of
colour.7 Furthermore, in order for dermatology to be more inclusive for racialized patients and providers alike, anti-racism and cultural safety should be incorporated into training and practice.
My patient encounter that morning reinforced my place in dermatology. As one of the few Black women in the field, I feel privileged when I can use my position to spread awareness on inequities and racial disparities. I hope to be part of a future where all patients, especially those who have been historically marginalized and underserved, have access to quality dermatological care.
References
1. Loussouarn G, El Rawadi C, Genain G: Diversity of hair growth profiles. Int J Dermatol 2005; 44(s1):6–9.
2. Haskin A, Aguh C: All hairstyles are not created equal: What the dermatologist needs to know about black hairstyling practices and the risk of traction alopecia (TA). J Am Acad Dermatol 2016 Sep; 75(3):606-611.
3. Mayo TT, Callender VD: The art of prevention: It’s too tight—Loosen up and let your hair down. Int J Womens Dermatol 2021 Jan 29; 7(2):174-179.
4. Koval CZ, Rosette AS: The natural hair bias in job recruitment. Social Psychological and Personality Science 2021; 12(5):741-750.
5. Bizimungu S: Is this hair professional enough? CMAJ 2021; 193(7):E254-E255.
6. Tripathi R, Knusel KD, Ezaldein HH, Scott JF, Bordeaux JS: Association of demographic and socioeconomic characteristics with differences in use of outpatient dermatology services in the United States. JAMA Dermatol 2018; 154(11):1286–1291.
7. Gorbatenko-Roth K, Prose N, Kundu RV, Patterson S: Assessment of black patients’ perception of their dermatology care. JAMA Dermatol 2019 Oct 1; 155(10):1129-1134.
Entries for the 2023 essay contest are now open. More details are available here.
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