In 2013, after being accepted into medical school, I stepped onto the conveyor belt to doctorhood. Whilst on this journey, I did not anticipate feeling a sense of discord between fighting for the cause and self-preservation. For example: I did not anticipate having to convince people that Blackface is not appropriate, even for a  student-led charity fundraiser. Along with a group of likeminded students, convincing the powers that the fundraiser was offensive required endless meetings with university representatives, which meant frequently having to take time out of my studies. Throughout our campaign, I was alarmed by the sheer amount of pressure we needed to exert for the university, staff and students to take us seriously. I could not stop thinking, “I should not have to push this hard for you to value me.”  So I was left with two options: I could stay at Cardiff University and continue fighting; or, I could leave the toxic environment with what I had left of my mental and physical health.

At first, these personal experiences and the experiences of others aroused a hunger to fight. I had to fight under-representation knowing that 80% of medical students come from only 20% of the schools in the UK. I had to fight the daily erosion of my self-esteem. I no longer wanted to contain the shame and smallness that came with being told that my 3mm hair is “unprofessional”, and should “be combed”. Or to be spat at by patients. Nor did I want to experience another patient refuse to be seen by the “coloured girl” or my “n*****” self. It was exhausting.

The Workforce Race Equality Standard (WRES) was set up in 2014 as part of agreed action to ensure BME NHS workers have “equal access to career opportunities and receive fair treatment in the workplace”. In theory, the existence of WRES should quieten those who maintain that such incidents do not take place. The workforce’s report in 2016 found that “BME staff are more likely to report they are experiencing discrimination at work from a manager, team leader or other colleague compared to white staff”. This didn’t surprise me.

Armed with this empirical evidence, surely we cannot remain neutral? Desmond Tutu stated that ‘“if you’re neutral in situations of injustice then you have chosen to side with the oppressor.” My initial analysis of this was that those being oppressed were separate to those that were neutral. However, when I heard yet another ‘it’s just how it is’ fall from the lips of doctors I was training alongside, I began to perceive the oppressed to also be ‘neutral’: by doing nothing we are siding with our oppressor. Arrogant and naïve, I judged this course of action: we should all be fighting. But I now realise that the act of existing in such a hostile environment is a fight in itself and it should be commended.

Sometimes you must step out of the ring. When you continually put yourself on the line, you fall off, and I have the bruises to show for it. In an attempt to better the experience of other black students at Cardiff University, I neglected myself. I absorbed the harassment, the insults and the astounding lack of desire to change within ‘the system’. Eventually, insomnia, depression and paranoia triumphed. I left. The difficulty is this: at what cost does self-preservation come, particularly in healthcare, given the complexities of our duty of care to patients?

Jeremy Hunt has been told that GPs are burning out; tragically, some do so to the point of suicide. Speaking at the RCGP Annual Conference earlier this month, Hunt announced plans to recruit 2,000 GPs internationally. He said: “we are going to focus initially on EEA/EU countries…[and] also going to look at our non-EEA recruitment.” In the context of an increasingly hostile post-Brexit Britain where 1,794 EU doctors left the NHS between June 2016 and June 2017, and WRES reported discrimination experienced by BME staff, what are we expecting of this migrant workforce? Are we asking these workers, more vulnerable to exploitation and poor working conditions due to their less concrete immigration status, to set their own wellbeing aside to preserve our NHS?

I took a year away from studying. After the reflection this entailed,  I have come to learn this: self-preservation is not separate from fighting the system, self-preservation is fighting the system. Audre Lorde said, “the master’s tools will never dismantle the master’s house.” Indeed, we shouldn’t even expend our energies using our own tools to dismantle his house. We should build our own house.

For me, this house was nourishment from a support network of black students and doctors who offered their attentive ears, homes and humour. From this support network came the African Caribbean Medical Association, ACMA. We want to equip and empower black medics to embrace their full potential whilst maintaining mindfulness. To do this, we are providing a platform for networking, mentorship and fellowship. This community has allowed me to dissolve some of my disillusionment about being a black woman in the NHS. A holistic creative approach is needed to build such a sustainable house. For this feat of construction, we’re innovating our own tools for survival.