This is part of our series of Patient Safety Spotlight interviews, where we talk to people working for patient safety about their role and what motivates them. Chidiebere is passionate about increasing representation of Black people in all forms of medical literature. In this interview, he explains how lack of representation at all levels of the healthcare system leads to disparities in healthcare experiences and outcomes. He outlines the importance of speaking openly about how racial bias affects patient safety, and argues that dispelling damaging myths about particular patient groups starts with equipping people with accurate health knowledge from a young age.
I'm Chidiebere Sunday Ibe and I'm currently a medical student at the Copperbelt University School of Medicine and also a medical illustrator. Currently I hold several positions—I serve as a chief illustrator at the International Center for Genetic Diseases at Harvard Medical School and also serve as the chief illustrator at the Journal of Global Neurosurgery. I am also the lead illustrator at Illustrate Change which is a project pioneered by Johnson and Johnson's and Deloitte. I'm passionate about representing Black people in medical literature and portraying areas in medicine that have been ignored in terms of portraying skin conditions that do not represent Black people, and also portraying areas in medicine where there is a cliché mentality that these diseases don't happen among Black people. Basically my work is to incorporate art and medicine together to communicate the message of diversity and inclusion and hopefully improve healthcare outcomes for everyone.
Why did you start creating medical illustrations?
During lockdown I met my mentor Dr Oric Sidney. I reached out to him as I wanted to work for his organisation as a graphic designer. He said there was no money to pay but I said, “Okay I want you to be my mentor because I am passionate about medicine.” I wasn't a medical student then but I was an artist, making art with pencil and pen. When he saw my artwork, he said “Why not go into to medical illustrations because you have passion for art and medicine?”
I decided it sounded interesting so I started doing research about what it takes to be an illustrator. I realised that I was at a bit of a disadvantage because I didn't have the resources or the knowledge. Everything I learned was self taught—I had to teach myself the software to do illustrations and I had to teach myself anatomy. I had to push myself to this point, but in the journey of teaching myself , I realised that there was so much under-representation of Black people both over the internet and in the medical textbooks. So I decided to see how I could solve this problem, how I could change the perception of people with illustrations. So I started creating Black illustrations and it has been a rewarding journey I would say.
Why is lack of representation of some patient groups an issue for patient safety?
It's really a critical issue for patient safety because we talk about cases of misdiagnosis; we've had cases where patients are misdiagnosed because of lack of representation or because of lack of accurate representation. Some time ago, there was an interview that was carried out in Nigeria where medical students were asked what heat rash looks like on Black skin and they said it looks reddish. That is a wrong representation because it doesn't look red on Black skin, because of course the whiteness is not there to see the redness. But because the resources that are used in training medical students are all white-centred, medical students are actually being trained to misdiagnose skin conditions.
It has also led to delayed diagnosis. I had a time where a patient shared with me that she had skin ulcer, but when she went at dermatologist they said that Black people don't have skin ulcers. Then because of this lack of knowledge, treatment was delayed and her health outcome became worse and the case became more aggravated than it should have been. So this is because of lack of representation—if this was represented then most medical students who become doctors would have the basic knowledge of how to diagnose this simple skin condition.
One other thing I would say is that there is a lack of understanding about the risk factors that cause diseases or cancer. For example, today I created a piece on prostate cancer and one of the risk factors for prostate cancer is race. One in every four Black males will have prostate cancer, but yet we can't understand why the statistics are there. Because of lack of representation, we don't have this knowledge due to lack of involvement in clinical trials. We don’t know why this thing happens more among Black people. In my opinion, knowing certain things can be critical factors for patient safety.
Which part of your role do you find the most fulfilling?
I've been blessed to have several roles and work with several people, but one of my roles also is taking time to read through the comments [on my social channels]. I go through the comments and read through people sharing their own experiences. Sometimes people share how my artwork has changed their life and how they feel seen and heard—for me that's the most rewarding part of my work. I have had the opportunity to work with a lot of great people but I think the feedback I get from people is the most rewarding part of my role as an illustrator or my role as an advocate, or as someone who is passionate about representation. So I'm just always excited when I get to read comments and hear people’s feedback about the kind of work that I do.
What patient safety challenges do you see at the moment?
I would say one of the big challenges is the stereotypes and bias in the healthcare space, because if we are in a system where healthcare outcomes improve generally, but not for certain populations, then there is healthcare disparity or bias. If there is the stereotypical approach towards healthcare for that population, then that population is at risk, so of course you wouldn't say there is safety for the patients there. So in my opinion one of the major things is healthcare bias.
Some time ago, I read something about the idea that Black people have nerve endings that are less sensitive, meaning they have higher tolerance for pain. [The result of this misinformation is that] when Black pregnant women go to hospital and complain about pain and the doctor says, “You're a black woman you should have a high tolerance for pain because the nerve endings are less sensitive,” the patient is at risk. And that is because of this stereotype that has been transferred from generation to generation and system to system, and this has affected patient safety. If we can address how we perceive certain populations, that would go a long way in improving patient safety for those populations, and possibly for all populations.
What can we do to tackle these challenges?
In my opinion there are a few things that can be done because the key idea behind bias or stereotypes that affect patient safety is all about information. If a child is growing up being taught about healthcare [they may be] being introduced to certain cliches around populations. For example, if I have a child and I tell them that all Black children don't feel pain, that is a piece of information the child grows up with. The only way to change that information is to bring in superior information, so in my opinion, the only way to address this is to have a system that educates people about the reality of these facts.
When I created the Black foetus illustration, people started realising that this is something they have been missing for years now. Many people realised that there something missing in healthcare, which is [the subject of] bias and health. So people started talking about it and that's one thing about my work—it has be able to shape difficult conversations. People were scared about talking about bias, scared of being called out as as an activist or as an advocate or something. But now because of the information out there, people are now bold enough to share their own story. People are now bold enough to talk about issues like this.
I strongly believe that with accurate information, teaching people and integrating this into the curriculum in school systems then we can say we are slowly addressing the bias in healthcare and ultimately improving safety for our patients. [We need to allow people] to understand that this is a quiet pandemic eating up our system,
If you could change one thing in the healthcare system to improve patient safety, what would it be?
Tough question, right! But I think if I could do that, I would simply change people’s perception towards particular populations, because if I change my mindset towards a population, the way I treat them will be different. It has been proven by research that health outcomes can improve if the physician looks more like the patient—that patients feels more confident if their physician looks like them. That's to say that there will be an improved outcome if we change the mindset towards certain populations and we treat everyone fairly and equally. I believe this is where all of this starts.
Are there things you do outside of work that make you think differently about patient safety?
One thing I would say that I do outside of my work is having meaningful conversations with people. Over time I have come to understand that people have a lot to share, but sometimes they don't have someone to listen to what they have to share. So, in as much as I'm always the one on the side of speaking about my experience or my work, I always just love listening to people talk about their own knowledge, [thoughts on] patient safety and their own experience. I would say this has also supported my work because when I listen to people, I learn from them too and that also supports the kind of work that I do. So outside of my role as an illustrator or as a speaker and advocate, I just love listening to people—to patients and to other speakers sharing their own knowledge. I think that alone can be like a support system for me. It is part of my learning which can also help in patient safety.
Tell us something about yourself that might surprise us!
I've done a lot of interviews like this and said a lot of things, but I don't if I've mentioned this before—I have a very powerful intuition. Sometimes I get to know things and I don't know how I know them! Sometimes people ask me questions that I've never heard before but I just have the answers to them and sometimes I wonder, “How did you do that?” I don’t know yet how that happens!
*[Additions have been added in brackets for clarity]
About the Author
Chidiebere Ibe, BSc, is a Nigerian medical illustrator, TEDx speaker and medical student. He is passionate about contemporary illustrations of black patients and has been acclaimed globally for creating the black fetus illustration. Chidiebere is the founder of Championing Change Africa and Creative Director at both the Association of Future African Neurosurgeons (AFAN) and the Young Continental Association of African Neurosurgical Societies (YCAANS). He is also Creative Director and Chief Medical Illustrator at the Journal of Global Neurosurgery, a Medical illustrator at the International Centre for Genetic Diseases at Harvard Medical School and the Lead Illustrator at Illustrate Change.