Some of the formative educational experiences described by Olamide Alabi, MD, read like textbook examples of the subtleties many see as baked into U.S. society, multiplying down the years as the very face of systemic racism in the country.
These days, Alabi is an assistant professor of surgery in the division of vascular surgery and endovascular therapy, department of surgery, at Emory University School of Medicine in Atlanta.
Back in her schooldays, she was the gifted daughter of immigrant parents from Nigeria—her father a scientist, her mother a social worker—who raced through advanced classes in math and science, yet still found herself sent to a McDonald’s franchise on work experience while classroom contemporaries were lined up with professionals such as physicians, college professors and lawyers. “Interesting is one way to describe that,” Alabi muses.
The stark juxtaposition between her academic abilities and the measure of a guidance counselor jarred, too. “They talked to me about tech opportunities, community college opportunities, as opposed to university-level opportunities.”
These might seem like isolated, unfortunate events or microaggressions, Alabi says. “But if I would have gone along the path of those people, who I’m sure meant well in some respects, I would never have become a surgeon, that’s for sure.” She credits the engagement of her parents for helping set her on a trajectory that might otherwise have ended somewhere far short of her capacity.
Onward through college and beyond into her faculty and vascular surgery career, a similar theme runs as if a thread from those early experiences: “These things don’t change, unfortunately, and there’s very little support for Black and brown people who look like me and who go through these things at all levels of academia.”
The reinforcement of white male culture through the use of such surgical mannequins represents another signpost identified by those who’ve been on the conveyor belt.
Alabi has other examples. “I can talk about elementary-age or school- age children: When you have children who want to play with dolls, by and large those dolls, if you’re an underrepresented minority don’t look anything like them,” she explains. “When it comes to mannequins or lectures that are provided on, say, dermatological manifestations or (a), (b) or (c), those manifestations are almost exclusively pictured on majority members of society, so predominantly white and predominantly male.
“I remember we would have a Black patient come in with a particular rash, and people would say, ‘I don’t know what this is. I have never seen it on this skin type.’”
Alabi shifts to the particular racial disparities exposed in the world of vascular surgery. Indeed, she was drawn to Atlanta in part to tackle disparate outcomes in lower-extremity vascular disease among people of color. The systemic fault lines are to be found up and down the system. “One of the reasons I moved to the southeast was because, number one, there’s a high proportion of underrepresented minorities who are the patients here, so a lot of Black and brown people. Another reason is because the rates of lower extremity amputations are disproportionately high in this region and that’s something I particularly wanted to focus on.”
She then poses a pointed question: Why? “The predominant theme that I would hear is: ‘It’s the patient’s fault.’” Rationales she hears for assigning blame onto patients: They come in too late; they lack trust in the healthcare system.
Alabi is having none of those explanations. “Since being here, just talking about the ones who come in ‘too late,’ I find many of these people find themselves under the care of a physician—not a vascular surgeon—for years,” she says. “They were doing their best to be seen about their problems and that problem was not appropriately addressed.” Which neatly sets up Alabi’s career ambitions as an academic surgeon: “I am an early career investigator and my overarching goal is to reduce the rate at which people get major lower-extremity amputations and particularly targeting vulnerable populations, being Black and brown patients as well as veterans.”
She is plagued, though, by a bigger question. “There are a lot of studies about health disparities and health equity, particularly when it relates to ‘Black race.’ But what does Black race mean? If there’s no real genetic component that predisposes people to have these poor outcomes, then what does Black race really mean? Is it a surrogate for a high-risk group based on where they live—so is it place not race? Is it a surrogate for a higher rate of—or higher rate of untreated—comorbidities, so microvascular disease, hypertension, smoking, diabetes, renal disease? To me, Black race is the way that people have tried to frame this, knowingly or unknowingly, so that it is unsolvable. I think the bigger problem is actually the social determinants of health, so it’s place not race.”
On the ground, in places predominantly Black or brown, signs of disinvestment can be stark. It’s often chronic, going back hundreds of years, Alabi points out. “These pre-pandemic ills have been going on for so long, they’ve been pervasive and there has been no real public health push to fix these things. Because what’s the bottom line
if you’re a policymaker? Why do I have to fix the fact that there are food deserts in these particular locations? There’s no accessibility to healthier foods; you can’t even find a grocery store; there’s more or less only fast food locations everywhere. How do you fix those things, should we fix those things and how am I going to allocate money to something like that? Clearly, it hasn’t been important from a political standpoint.” That is to say, Alabi concludes, the social determinants of health are just as important as the political ones in the theater of disparities and inequities.