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do I click present now? So if you click on present now and then if you go to share screen, screen and then the window and find your your presentation, Mr Sang Rajya is going to talk to us about understanding racism. Thank you very much. Right. So And as everyone has said, I now can't see you. But can you guys see my slide? Yes. Thank you. Right? Yes. So I'm Anish. Um And it's a really weird title, isn't it? Understanding racism, Because is that what we're supposed to do? Um, so what am I going to say? So you've always got to start to talk with disclosures and disclaimers. Uh, so these are my views and opinions. Okay. Maybe unbiased. Uh, these are definitely not General Izabal. Okay, not everyone thinks the same and actually would be really cool. But I want to see you So some people can tell me if there are questions, but feel free to question me. The whole point of this is making it interactive. It was great when Kem Panos we're engaging and asking questions and I think something like this is that kind of topic. There isn't necessarily a right or wrong, but the facts of the facts and you need to listen without prejudice, and you're gonna have to accept the facts. Okay. Uh, now, when Kate gave me this topic, I was kind of thinking, Oh, man, uh, this is a definite minefield, isn't it? There are so many things you can say or do that could possibly offend. And so I'm gonna I hopefully will navigate this successfully. So what do I want from the talk? I want you to think about racism. Uh, what it is the impact it has on you and your colleagues, whatever your background, uh, the impact it could have on your patient's. We're gonna talk about behaviors and comments that you might want to avoid. And then, um, I think it's probably important you have a little understanding about me. So I see myself as British Indian. Okay, I was born in this country, so I think that makes me second generation. Um, I went to a UK comprehensive, and I trained at King's, so I have a different background to some of the other people who might call themselves British, Indian or Indian. Um, but I can honestly say I've experienced racism. So I think I have a little bit of validity in this talk. Okay, so what is racism? And it's really hard when you think about it to try and come up with a definition yourself. So I I use the Cambridge Dictionary website, and there's a couple of definitions that we're gonna talk about. So the first thing is this harmful or unfair things that people say do or think, based on their belief that their own race makes them more intelligent, good moral etcetera than people of other races. So you could say, Well, isn't this another form of unconscious bias? And possibly I'm sure there is a big overlap, but I think it's about the effect it has on the other people rather than just your own beliefs. So, um, his seen one. So yeah, this was me, uh, New Year's Eve party, 2018 with a good bunch of friends, not friends from childhood. But over the last few years, a late 40 something white British mail says to me. But there's not really any racism these days, is there? And you kind of think well, so I did, because I know him well. I said, Well, how do you know? And I think the same applies to a lot of the bias is we're talking about today. And actually, we've heard people mention though, so it would be very hard for me to say to someone. Oh, I know your challenge as a female in surgery because I'm a brown man. I really don't. Okay, But I think there are lots of examples that hopefully clarified that racism is still rife. Okay, this is the Euros. 2020. This guy was brave enough to take a penalty, and he missed, uh, and then on Twitter, someone tweeted. You can guess what the stars are. Uh, my dead man could have scored that, so fortunately, uh, he was jailed. Okay, uh, but that's clear, obvious racism, but it still goes on, but what we're talking about, you know, that kind of stuff doesn't really happen. Fortunately for most of us, day to day. But how about these things? Okay, So because it is quite complex, um, and, uh, we always talk about shades of gray. This is the 19 seventies. Okay. The black and white minstrel show. This is on BBC. This was also on BBC in the 19 seventies, and it's called a half hot Mum. Uh, and it was about the British Army in India. It was a comedy, a sitcom made by the guys who made Dad's army. Uh, and I have to say, when I was young, I really enjoyed watching that. And it was quite nice to see a brown guy on TV like he's got a turban and everything. His name was Michael Bates, Uh, and he had no connection to India, and he was browned up just like the guys. Uh, a wearing blackface. So, um, I'm gonna and well, I don't know. Can we do this? Can we have a poll? Because I have created a poll there. Are you guys able to flush the pole up or you have to stop sharing? I'll give it a go. See, it says one that says, Is this racist? Actually, No. Let's leave it for now. Kate, I think this one I'll be really gutted if anyone puts No. Okay. So I think it'd be fair to say these are clear examples of racism. Okay, Uh, you cannot do this, but how about this? Ok, so many of you recognized does. Can anyone tell me what the film is? Turn your mics on shoutout thunder. Yeah, Okay, so it's really weird. I was watching this a couple of weeks ago with the kids are saying, Oh, you got to watch this. It's a great film and here you've got Robert Downey Jr. Who is an American Caucasian. You're white male who was actually playing an Australian actor who has blacked up to play this soldier. And it's really interesting because I was watching this and I mean, you know, my wife was saying to the kids and you probably couldn't make this film anymore. And this is only from 2008, And when he made it, Robert Downey Jr was aware that this might impact his career because the other film he was making at the time was something called Iron Man that he thought might be successful. Um, and what's interesting about this film is if you actually watch it. Uh, I would agree with this from the Internet. Okay, this is from screen rant, and what they said was actually avoided controversy. Robert Downey Jr actually got nominated for a load of awards Golden Globe and Oscar. He lost out on each of them to Heath Ledger for the Dark night. But it was only in this film that terms like whitewashing reached prominence. Uh, and actually they highlighted this. And when you watch this, you realize that they're not actually marking a particular, um, type of person there marking Hollywood. And there's a really big difference. Okay, but what's interesting is Jamie Foxx, who many of you may know, uh, he's an African American performer, actor singer. Uh, this is a quote from him, and he'd watched Tropic Thunder and said, Man, you played the black dude and you killed that shit. We gotta be able to do characters He said, I'm making a film and I want you to play a Mexican. And in that film, Jamie Foxx played many roles, including a white police officer. This is Robert Downey Junior in 2016. As the Mexican has anyone here watched All Star Weekend, which is the film? Has anyone here heard of it? They never released it. It was 2016, uh, and Jamie Foxx has had it shelved, and his quote was, We can't release it until people go back to laughing again. So this shows you the controversy here in case you got Tropic Thunder did. Well, everyone thinks it was a good film. By and large, I think, but everyone you know, people might have different views. Uh, and actually, a person who is African American made a film in which people are playing different characters, uh, races, uh, and has decided not to release the film. So I hope what I'm showing you is that this whole thing is quite complicated. And then what about this? Now, this is starting to get a little bit older. Case, this was about 1982 as a British Indian growing up in this country, this film was massive. Uh, has anyone seen Gandhi? And does anyone know who played him? Can Mike Son Ben Kingsley? Yeah. Brilliant. OK, so so is this racist? You've got Ben Kingsley playing Mahatma Gandhi. A British person playing an Indian person. Some. Some people have said, Well, isn't that like a German playing a Jewish character? And you could argue whether that's right or wrong as well. Um, and so this one got me thinking, Okay, that's Ben Kingsley on your left. Uh, and you've got Ben Kingsley as Mahatma Gandhi on your right now, But this is a quote from the Indian Economic Times. Uh, sir Ben Kingsley much loved in India for his award winning performance. So they in India apparently didn't mind the fact that he had ground up. And Johanna Nehru, who was the first prime minister of India. So, you know, he was very good friends with Mahatma Gandhi. Uh, nationality is unimportant. All that matters is that he should be very good. Besides, the idea of being portrayed by an Englishman would have made Bopolu. That's, uh, the affectionate term for Mahatma Gandhi. Laugh a great deal. Okay, So while I was reading about this cause I have actually been I've been on a journey, I think for quite a while now, but Kate's really forced it in the last few weeks. I came across this. What I didn't realize is Ben Kingsley is half Indian, and actually, his dad is from the same part of India that I am so good drug. Um and actually his name is Krishna bungee pundit. But what you can see here from Wicki is a quote from the radio times. He wasn't getting jobs in the 19 sixties. And so he changed his name, his stage name, to Ben Kingsley and started getting a load of jobs. I think that says a lot about society. And if I tell you I did the same thing in 1995 when I was working a survey call center, um, they found that I had the lowest hit rate. You'd phone up people who had agreed to be in a survey, and I'd say, Hi, my name is an issue garage, blah, blah, blah, blah, blah. And most of them would say, No, we don't have the time. My manager came to me and said, Why don't you try Andy Smith? Uh, and I went from the lowest to the highest performing person that summer, right? Seen two last week. Okay, um, I would like to see if we can get the pole working here. So someone says to me, What are you eating? That smells nice. And I said, Doll mcny, Dull muck heap. Uh, no doll mcny. And then, uh, they said, no, no, You mean dull muck. Keep dull muck. Keep Ha ha ha ha ha! So hopefully you guys can see a poll now. Um, and so what I'd like to do is say, Was that racist? Are you not sure? Or do you think? Actually, it's okay. Fire away. So hopefully you can see it now. Right? So thank you very much. This is working. Johann says he can't see the poll. I'm not sure why, John. The others, I think, can have a look on the chat section in polls. I don't know if it'll let you answer there. Um, I don't think that they will have access to the poll section, but it should. You should just have the pole. Should just flashed up. Right? So right now we've got 70% have said racist. 23% said Not sure, and 5% said it's okay. Okay. Um right. We'll carry on and we'll talk about that scenario a little bit later on. Okay, Now, we talked about one idea of racism, so it's kind of about the individual. Now we're going to talk about policies, behaviors and rules that result in a continued unfair advantage to some people and unfair or harmful treatment of others based on race. So it's what we're calling institutional racism, isn't it? Um, now, the BMJ did a whole issue on racism. I think it was last year, and what you can see from this quote here is institutional. Racism refers to how the norms, policies and practices of institutions negatively shape the experiences of members of racialized groups. Um, they provide a context within structural forms of disadvantage and interpersonal racism are concentrated and amplified ethnic minority people having a higher likelihood of more negative pathways through care, poorer access to effective services and interventions and poorer outcomes. And I suppose the question is, is the NHS and the system within which we work institutionally racist. And let's have a look at what the evidence is. So some of the other stuff that we discussed was maybe opinion. It's hard, isn't it? Is Tropic Thunder racist is, uh, Ben Kingsley playing Gandhi racist? I don't think there's a right or wrong. Now we're gonna start looking at some facts. This was when I had started around looking at medical school case. This was 1993 in the BMJ, a couple of guys, and this has been done in lots of many professions before. But what they did in the early stages, you had to apply for S H O jobs by, uh, CV. And they sent 46 applications out, and all they did was change the names. The CVS were the same. They applied for multiple jobs for each job they sent, uh, CV with an ethnic sounding name and one with a clearly English sounding name. And what they found was that yes, there was a big difference in short listing, based only on the name. This was the day before it was due to be published. They were arrested, okay, because they were being suspected of fraud because people thought what they did was not right. Uh, I think that's really interesting, but actually, they still got their little paper published. And what they proved, unfortunately, hasn't changed. So this is a bigger study now, So now people are doing it in an official way rather than doing these kind of, uh, incognito studies. So this is the medical workforce race, equality standard. Their report looking at 2020 but from 2021 was when it's published. There are similar reports for workforce in general, but as of 2020 so This was the first report they had introduced, uh, specifically looking at the medical workforce in the NHS. 11 different indicators. This is very relevant for us. I'm not going to go through all of it. Um, but here's the first one. Okay, So what they looked at was, uh, headcount of doctors. So here, you can see in that first table headcount percentage White versus bme versus unknown. Um, and what I'm going to draw your attention to is the bar chart. Okay, so the first one there other doctor grades below the level of consultant bme 47% consultants, 37.6% of bme. And then you look at clinical directors and medical directors and there's a massive difference because the proportions should stay the same, shouldn't they? They shouldn't be halved. But that suggests that maybe there's something funny going on then, uh, what I did do. So this is the G m C exam report case. This is all available in the G. M C website. This is our dinari. Um, but what you can see is it's all available. This is not confidential, but one of the reasons I put this up because I think people we we talk about the differences for gender. Um, but I think sometimes races overlooked and it's always a little bit uncomfortable saying that. But if you have a look here, OK, UK man woman, your purpose rate is about 80%. If you're an eye mg, it drops to about 50% higher for the women than the men. And even if you're from the E, you're European Union. It's a significantly lower, Um, and you can see the same here. Okay. And so we're talking about differential attainment, aren't we? And that's become a bit of a buzz word, but I think many people have known this. It started many years ago when BPO try to take the R C G sort of the Royal College of General Practitioners to court's about their exam pass rates. But if you look at this Post graduate specialty exam, pass rates in all royal colleges, Okay, bme white. If you're an E a graduate, even then as a B m e, it's lower than the white guys and the same with international graduates. And if you look at the A r. C P outcomes, uh, remember these are unsatisfactory outcomes. The B mes Uh, except for international medical graduates, there are still big differences. So differential attainment is a definite thing. And is this the system being prejudiced in some way against those individuals? And then there's the BMA survey. Okay, This was based on 2000 responses between October and December 2021. This was published last year, and so 2000 doctors replied, To what extent do you think racism problem in the medical profession? Dark Blue is a great deal of a problem. Turquoise is a fair amount of problem case, so at least 80% I felt that it's a problem. And that's overall, uh, if you look at the different backgrounds, you can see that there are differences. If you're from a white British background, only 14% felt it was a great deal of a problem. But still 48% felt felt. It is a fair amount of a problem, so I think it's fair enough for us to say we probably all agree there is a problem. What do you think are the main drivers? Well, the biggest is dark blue, and that seems to be individuals holding racist views, assumptions or behaviors, which is pretty damning because when you think about it, as doctors were probably more compassionate or we should be, uh, than most other professions. And I actually genuinely believe we are. I think it's probably more comfortable working in our system than it is, say, in the corporate sector, um, or similar industries where I think it's probably much, uh, there's probably much more bias. Okay, Um, and then the other drivers they've put here, So the other big bar is structural and institutional factors that disadvantage people from ethnic minorities. So I think it's fair to say people are saying this and we've got the evidence that says this as well. Okay, you look at the jobs and you look at the exams and even a ercp. So that's the profession. What about the patient's? Okay. So rates of surgical consultations after Emergency department and mission in black and white Medicare patients'. This is from JAMA surgery. So this is clearly an American study. What's really interesting is all of these studies are from America. People are looking at it. I haven't found one from the UK yet, and yes, basically, if you were a black Medicare patient. You had lower rods of being referred onto surgery when you were seen in the E. D. Even with cerebral palsy, if you are black, you have a higher risk of complications and having to undergo a hit salvage hip procedure than if you're not. And there are loads of papers. Okay, um, the one that hadn't talked about someone who presented that was published in JPO, where they talked about implicit racial bias being prevalent amongst pediatric orthopedic surgeons in North America. But it looked as though it probably doesn't. They actually did case scenarios, and they felt it probably didn't affect patient care. But this is actual evidence that your race determines the treatment you're being given. And then finally, let's talk about the workforce. Okay, so this is a a report that came out last year, and I thought it was quite interesting. I don't know if you guys saw it. What they found was a dramatic increase in international medical graduates. Uh, UK graduates joining the workforce rose by 2% from 2017, compared to 121% rise in international medical graduates. Now we could do a poll here. How many of you feel that there are too many people in your department? How many of you feel that your rotors are overstuffed and you don't know what to do with your time? Okay? I suspect the answer is not many. I think we We all know the system is struggling. We haven't got enough staff, We've got rotor gaps. And this is despite this massive increase. Okay? And even the G m. C. Has put in this report that it would be mistaken to look at inclusion from a purely ethical viewpoint. Of course, it's the right thing to do, but it's a crucial factor in productivity and workforce retention. By making a priority, we can encourage much needed doctors to remain in UK healthcare and make the most of their potential. So basically, if we don't take action, we'll be doing a disservice not only to the doctors who want to work here, but also to the patient's in need of their care. I think that is an excellent summary of the problem we're facing. Okay, we need people to work in our system. And if we don't look after him, uh, these guys can go away, OK? We're all stuck in the NHS. I'm a UK graduate. Um, someone who lives in the UK It's going to be hard. Uh, I think many people are looking for an escape route. And so all of this Okay, sometimes it's very easy to go. Oh, yeah, but look at this. This is all you know. Uh, you're taking my privilege away. Um, but what we're talking about isn't anti white, okay? It's about, uh, taking away. The disadvantage is, um who is this? A quote from there had to be something related to wrap. Right? I know. I don't know. Helen Bryant still listening, but it's not from that song. We talked about anyone. Anyone Tell me where that's from. Yeah. Yeah. Crown. Okay now. So, racism, we talked about the stuff on Twitter, Um, with Marcus Rushford. Helen is going to talk about this on Monday, so I don't want to go into into massive detail, but what I do wanna put we can talk about microaggressions. Okay, What does that mean? And these are little things that people say on a regular basis, Say do or things that come up in the environment that basically communicate hostile, derogatory or negative slights and insults to marginalized individuals and groups. Okay, essentially, it can seem really insignificant. They're minor little things, and it's very easy to say the victim is being overly sensitive. Okay, but they are underpinned by racial stereotypes. I always wondered why it's called Micro, and the reason being is it's because it's personal person as opposed to systemic racism. Okay, it's still racism. So, microaggressions, where are you from now? Clearly that hit the headlines earlier this year or sorry late last year, because what you're implying to some people is that they are an alien in their own land. Okay, because if you ask me that, I've told you I'm from north west London. I'm a hair Oh, boy. Assuming the competence of people whose first language is not English, I want you guys to think about this. How many times in a busy clinic have you listened to someone who may have an accent or speak slowly? I just kind of assumed that they don't really know what they're talking about. Um, have a think we're not going to be a pole mispronouncing a non Anglo name after being corrected multiple times. Um, as you can imagine, people have struggled with my surname. Okay, What amazes me, though, is that six year old Children in my clinic can say my surname. Most of you were able to say deoxyribonucleic acid, Uh, and pride yourself on it when you're a certain age, so you can say these names. And the worst thing is I won't even try and say that that's really complicated. Have a go, is what I always say to people. So please do have a go. And if you get it wrong, you could say I might say this wrong, But is it, um that's much nicer, Okay? And yeah, I'm not racist. I've got brown friends or I'm not racist. How can I be? I'm Brown, Okay? These are microaggressions, and then the other one making racist jokes and then dismissing them as harmless. I don't know if you guys heard about the football manager yesterday who got done The FAA, we're trying to get him banned, but for life. But an, uh, an independent panel have only given him a 15 month suspension, and his racist jokes included things like calling people of Asian origin curry munchers. Uh, and terrorists. Okay, um, these are the things that do go on. And people just think it's all right. You know, I assisted a bit of a joke. Don't take it so seriously, and that's a micro invalidation. Okay, uh, and I think as someone who's brown, I do worry about micro invalidation because when that dull muck keep thing happened, uh, I was a bit annoyed, and I thought, Well, if I raise this, they're just going to go. You're being overly sensitive. Uh, so the problem is, I'm already sensitive about receiving a micro invalidation. But that's where you tell someone that they're just essentially, you're gaslighting, okay? You're telling them that it's not that serious. Get on with it. And these are the kind of things that you might say. The reason why this one doesn't matter, and we hear that a lot. OK, uh, it's not color. The world should be colorblind, actually, Then you're negating people's experience when you've got evidence in front of you that being, uh, kind of brown origin black. These things actually do adversely affect your life. Then saying that color doesn't matter is dismissing the reality. Okay, all lives matter. That kind of came about, didn't in a couple of years ago. And actually, I was reading something really interesting about that. It's a bit like having 15 houses in a road, one on fire, and then the fire brigade coming along and spraying water on all of them because all houses matter. I think that was a good analogy. You're imagining it. And then this one, okay, the myth of meritocracy. Hopefully we've shown you that that's not true. The system, unfortunately, isn't allowing this. Okay, so in conclusion, right, What do I think? I've hopefully taken you through. I've taken you through something that's making you think. Hopefully you've got the proof in front of you that racism is still alive and kicking. Hopefully, you're going to accept the clear evidence that us as individuals and the system need to change to make things fairer. And hopefully you're gonna be a little bit inspired about being that change, because you can now see these problems and hopefully from this afternoon. Actually, there's been a lot of positivity, and I'm really hoping that everyone is going to take that forward. And I think when you're thinking about being a minefield. Actually, it's all about context and intent. So when someone says to me, where are you from? And I can tell they actually are genuinely interested. Uh, I I will actually say, Well, I'm from North West London, but my parents originally from India, Uh, I've got no problem with that, but if I've had a patient asked me that because they were questioning my medical opinion, uh, that doesn't go down so well. So always think about your the context and the intent. Okay? And then the other thing is, these things may not affect you directly, but you might see them affecting people around you. In which case, uh, the next talk. I think it's gonna be really useful because I want you to be an ally. Okay, So, uh, and yeah, we need this. Okay? The NHS and our society really need this. Uh, yeah. So Anna said at the beginning that you got to include photos of your family. So that's one of those. And Marcus Rushford. Okay, So this is a mural in Manchester when that thing happened. Someone graffitied something. Apparently really nasty all over it in the middle. I tried to find out what, and I couldn't. Okay, All they're showing is pictures with black tape over it. But this is, uh, the outpouring of kind of support from him for him from everyone around. And I think that says a lot about our society. Okay, so I'm actually pretty optimistic, but I think it's these little things we're seeing progress we're not seeing so that just for your interest BBC have banned it ain't half hot, Mum. They've not shown it since 1984. So society is moving forward, but we can't just say it's all okay, We're there, Okay? There is movement to be made, but look at this. This is so cool, Right? Thank you very much for your attention, guys. Any questions? Now? I got to try and work out how to stop share ink. Thanks, Anish.