Medical student Malone Mukwende’s book on why brown skin matters meets with ‘phenomenal’ response

A British medical student says there’s been a “phenomenal” global response to his handbook about how conditions look on black and brown skin.

Malone Mukwende developed the Mind the Gap: A handbook of clinical signs in black and brown skin, with the backing of St George’s, University of London, after he noticed disparities in medical care.

“I realised that the problem may lay in the fact that we’re not often taught on darker skins,” he said.

“So that’s where I knew that I kind of had to do something to address this problem, because there was nothing that I could see being done.”

The free online handbook details the clinical presentations on skin of colour for more than 20 conditions including swelling, nail pitting, jaundice, meningococcal disease, bruising, chickenpox and measles.

He said it had had received an enthusiastic response around the world in the three weeks since it was released, including from Australia, particularly in relation to Indigenous communities.

“Doctors often find it difficult to treat patients from those communities, which is quite shocking, given that they have been habitants of Australia for many, many years,” Mr Mukwende said.

“If I was to rank it in terms of interest, of course the UK is at number one, then the USA and Canada, then after that Australia is like fourth.”

Australia welcomes resource

The Australian Medical Council, which is the national standards and accreditation authority for the profession, has welcomed the resource.

“Teaching, training and medical practice resources, like this, that help to show the breadth of the community would be welcome,” the council said.

So too has Australian dermatologist Michelle Rodrigues, who said during her training at medical school in the 1990s and 2000s “there was nothing relating to skin of colour”.

“I’m of Indian background and I realised that a lot of images I was seeing in conventional textbooks were largely in white skin,” she said.

“Depictions and descriptions were those that would be most relevant for patients with white skin.

“I was a patient once and I had a condition on my back that I went to see a dermatologist for, but it wasn’t able to be diagnosed because I think, in retrospect, maybe because of my skin colour.”

Risk of misdiagnosis

The Melbourne-based doctor said a lack of awareness about skin of colour could lead to misdiagnosis or incorrect treatment because conditions presented differently on black, brown and white skin.

“The obvious way that it’s different is our inability to see the colour red in patients that have heavily pigmented skin,” Dr Rodrigues said.

“In white skin it’s very easy to see red and this is important because redness can be a sign of inflammation, it tells us the location of a rash, it tells us the severity of the rash and how deep within the skin a rash goes.

“In patients that have Chinese skin or Indian or African skin, this [eczema] is often seen as little small micro dots around hair follicles — so its actual morphology is different.

“It’s not just colour — it’s the shape of the rash that can be different as well.”

Shannon Springer, an associate professor of the First People’s health stream in Griffith University’s medical program, said the Western dominance of the medical profession meant that the majority of its evidence was based on “white-skinned, male populations”.

“The medical profession just has to do a lot better about looking at people with black and brown skin in all areas, not just dermatology,” he said.

“It covers all specialities.”

Dr Springer said medical students were often taught about conditions that impacted the Aboriginal and Torres Strait Islander people specifically.

But he said that content needed to be more inclusive so students could see how conditions presented on all skin types.

“The manifestations can look very different and the chances of misdiagnosis increase,” Dr Springer said.

Hopes for the future

Dr Rodrigues, who was instrumental in the inclusion of teaching of black and brown skin becoming part of the Australasian College of Dermatologists’ curriculum three years ago, said resources in this area have improved over the last 20 years.

“I think Australia definitely can do more and I’m really, really happy that this Mind the Gap book … has shed a little bit of light onto the area, because the more people we have equipped to deal with skin of colour, the better.

“It’s given a little bit of a voice to this issue that we’ve been working on for several decades.”

Mr Mukwende, now a third-year medical student, hoped this was the start of a more inclusive medical system.

“I’m hoping that with the incorporation of these things into medical curriculums and other health care courses worldwide, we can start to see a future where some of these healthcare disparities are reduced because the healthcare professionals of tomorrow are better trained,” he said.

“Hopefully in five and 10 years we can look back and say, ‘Although we had COVID and many other things going on in the world … there was some positive things that still managed to come out of 2020.”

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