A Zimbabwe-born medical student living in London is filling in an important blind spot in the medical community: informing healthcare providers and patients how symptoms for a broad range of conditions appear on darker skin.
It’s the kind of problem that feels shockingly outdated for the 21st century, but as 20-year-old St. George student Malone Mukwende recently told the Washington Post, the lack of teaching about darker skin tones, and how certain symptoms would present differently on nonwhite skin, was obvious by his first class at the University of London school.
“It was clear to me that certain symptoms would not present the same on my own skin,” Mukwende told The Post, referring to conditions like rashes, bruises, and blue lips. He quickly extrapolated that the same would be true of other people sharing similarly dark skin.
That realization led Mukwende to create a “universal tool” to help address the lack of training. With the support of St. George faculty, Mukwende, who recently completed his second year in medical school, is writing a guide for medical professionals: Mind the Gap: A Handbook of Clinical Signs in Black and Brown Skin.
The guide will contain images of how a wide variety of conditions—from psoriasis to COVID-19—show up on dark skin, but Mukwende also took particular care with the language used to describe the symptoms.
“It’s really about the words we use,” Margot Turner, a senior lecturer in diversity and medical education who is assisting with the project, told The Post. “We are looking to decolonize the curriculum and make sure the medical education is reflective of everyone.”
“Our methods of teaching were unfairly disadvantaging and ‘othering’ students from black and minority ethnic groups,” said Dr. Peter Tamony, who is also working on the guide and has been responsible for making sure St. George’s curriculum reflects greater diversity. “The other issue is one of patient safety. Are we adequately training our students to be competent health-care professionals who can detect important clinical signs in all patient groups?”
The name of the guide is inspired by the routine reminders given on London subway platforms, cautioning passengers to watch their step before they enter the car.
“‘Mind the gap’ is a warning sign to alert you of a danger and if you don’t do anything about it, there can be fatal consequences,” said Mukwende. “Similarly, if we don’t do anything about addressing the issue at hand, people will continue being misdiagnosed.”
Healthcare providers don’t just risk misdiagnosing Black patients by not noticing symptoms or describing them in insensitive ways. Fraught and frustrating interactions with medical professionals have contributed to a lack of trust between Black communities and non-Black healthcare providers, resulting in a reluctance to seek care.
In the spirit of community input, the Mind The Gap team intends for the manual to be a “live document,” with ongoing contributions from patients, medical students and clinicians, the Post reports.
The input is crucial to the manual’s mission. While other texts on how to assess medical symptoms on darker skin have been written, Mind the Gap aims to be unique in its accessibility and its ability to be responsive to the people who use it.
Dr. Minal Singh, the curriculum director at the School of Medical Sciences at the University of Manchester, told The Post the book identifies “an absolute need” in the medical community, one that centers Black and darker-skinned patients in a much-needed way.
“It’s not so much just the visual pictures that are important,” said Singh, “it’s understanding the story the patient has told.”