When racial trauma is a chief complaint among health-care staff

Abstract

The COVID-19 pandemic has not only revealed major health disparities in people of colour, in line with previous research findings,1Office of the Surgeon GeneralCenter for Mental Health ServicesMental health: culture, race and ethnicity. A supplement to mental health: a report of the Surgeon General. National Institute of Mental Health, Rockville, MD2001Google Scholar, 2Smedley BD Stith A Nelson AR Unequal treatment: confronting racial and ethnic disparities in health care. Institute of Medicine (US) Committee on understanding and eliminating racial and ethnic disparities in care. National Academics Press, Washington, DC2003Google Scholar but also highlighted the often overlooked impact of racial trauma on health-care workers. Racial trauma is emerging as a chief complaint among health-care practitioners dealing with the COVID-19 pandemic, underscoring the importance of acknowledging these invisible wounds in the clinical setting. Added to the emotional and physical exhaustion of caring for overwhelming numbers of critically ill patients during the pandemic, Asian American health-care workers have had to endure the trauma of racial discrimination. Whether in the health-care setting, when patients whose lives they are trying to save refuse to be seen by Asian American providers and accuse them of causing the pandemic, or in the community, where providers are called racial epithets, and even physically assaulted, they have been subjected to egregious dehumanisation.3Tran A Hero and villain: an Asian American doctor's perspective on being viewed as the solution and the problem.https://thehill.com/changing-america/opinion/499156-hero-and-villain-an-asian-american-doctors-perspective-on-beingDate: May 22, 2020Date accessed: October 20, 2020Google Scholar They have had to fear for their safety at the workplace and in the communities in which they live and serve. This abuse should give us pause to consider our health-care colleagues who experience such racial discrimination on a continuum, even in non-pandemic times. The Black Lives Matter protests happening throughout the world have brought the issue of racial injustice in the USA into the limelight. Health-care workers are no exception to these racial biases. The violence of racial trauma towards health-care staff is real, and the damage can be long-lasting. A Cambodian social worker, a co-worker of one of us, was called a racial slur and spat upon while travelling to work by bus 20 years ago. To this day, she brings this up as a major trauma equal to the traumas she faced under the Khmer Rouge regime (1975–79). One of us, responding to a page as an eager intern, can vividly recall the patient taking one look at her, a person of colour, and reporting that he wanted a white doctor. It felt like a punch in the gut. This isolated incident has stayed with her 17 years later. Racial trauma, similar to the refugee experience, is a human rights violation. It needs to be acknowledged and addressed. Staff may need mental health counselling. We need to be cognizant that interns and residents in training might be especially vulnerable during this pandemic.4Osseo-Asare A Balasuriya L Huot SJ et al.Minority resident physicians' views on the role of race/ethnicity in their training experiences in the workplace.JAMA Network Open. 2018; 13182723Crossref Scopus (177) Google Scholar With lessons learned from the refugee mental health field,5Mollica RF Brooks RT Ekblad S McDonald L New H5 model of refugee trauma and recovery.in: Lindert J Levav I Violence and mental health: its manifold faces. Springer, Dordrecht2015: 341-379Google Scholar we recommend the following when racial trauma is a chief complaint among staff at all levels of health care: (1) create a safe and trusting environment where staff feel free to share their racial trauma; (2) train managers and supervisors and provide them with the skills and time to listen to staff trauma histories; (3) engage in deep listening to the trauma story; and (4) provide concrete support, such as security, if necessary. We recommend tangible tools, such as the self-care protocol designed by Harvard Medical School and Massachusetts General Hospital, Boston, MA, USA, that health-care providers can use to maximise resiliency and wellness. These instruments acknowledge and help manage the heightened stress of racial trauma on staff of colour. It is time for all health-care staff to be supported in dealing with racial trauma as a chief complaint in ourselves and our colleagues. We declare no competing interests.