Creator of viral black fetus image will have his illustrations published in a book

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The attention came as a surprise to Chidiebere Ibe, the first-year Nigerian medical student who created the image, and describes it as “just one of my designs to champion diversity in medical illustrations”.

The image sparked a discussion about the lack of representation in these illustrations – images found primarily in textbooks and scientific journals to show pathologies and medical procedures.

Ibe, 25, creative director of the Association of Future African Neurosurgeons, has now been asked to have some of his illustrations published in the second edition of a manual designed to show how a range of conditions appear on dark skin.

“Mind the Gap: A clinical handbook of requirements in Black and Brown Skin”, was first published in 2020. Co-author Malone Mukwende, a medical student in London, wrote via email that “the work from Chidiebere … exposes some of the biases that exist in medicine in plain sight that we may not be aware of. Representation in healthcare is imperative to ensure that we do not allow biases implicit to develop in our heads.

Ibe, who earned a chemistry degree in Nigeria and is now studying medicine in Ukraine, only started his medical illustrations in 2020. He has previously created images depicting anatomy and a range of conditions, such as the vitiligo, cold sores, chest infections and spinal injuries, all in blacks.

Ibe says a lack of illustrations of black skin conditions makes it difficult for medical students to diagnose them. Mukwende hopes that together they can create “the blueprint of the world” in terms of what various medical textbooks should look like and that “Mind the Gap” will be known as “the reference manual for representing a variety of skin tones”. ”

A “big gap” in representation

Dr. Jenna Lester, an assistant professor in the department of dermatology at the University of California, San Francisco, describes Ibe’s illustrations as “incredible.”

Lester is the director of the university’s Skin of Color program, which provides a space for Black, Asian, Latinx, and Native Americans to understand the conditions that affect them and become more comfortable seeking care. She says she realized there was a ‘big gap’ in representation in dermatology when she was a student, and a lecturer told the class that a certain condition would look different in darker skin. , but not how the condition would appear. Lester says she’s “grateful” that now “people are actually responding and acknowledging that this is a big problem and making changes to address it.”

Chidiebere Ibe started creating medical illustrations in 2020 and depicts a range of conditions and anatomy, all in black people.

“I think it’s important to increase representation at all levels because … who knows what young mind it inspires when they see themselves represented in this way, who might be inspired to go into science or become a doctor or nurse or something like that, seeing themselves depicted in these illustrations?” She adds.

Studies have shown this lack of diversity. A 2014 study by researchers at the University of Wollongong in Australia examined gender bias in anatomy textbooks and found that of more than 6,000 images with an identifiable gender published between 2008 and 2013 in 17 textbooks, the vast majority were white and just over a third were women. About 3% showed disabled bodies and 2% elderly people.

Covid-19 exposed health care disparities

In some western countries, people of color have been disproportionately affected by the Covid pandemic. Research by the CDC found that racial and ethnic minority groups had higher rates of hospitalization and emergency care for Covid-19 than white people in the United States.

Lester says, “Covid-19 has brought to light a lot of disparity issues, and that got us thinking about disparities and all the ways they manifest, including in dermatology.”

The vast majority of images in anatomy textbooks are of white people.  Ibe is working on a manual on birth defects in children, which he says will be illustrated with images of black skin.
Lester co-wrote a search letter published in the British Journal of Dermatology in May 2020 which found that scientific papers describing skin manifestations of Covid-19 “almost exclusively show clinical images of lighter-skinned patients”, with no published photos of dark-skinned manifestations . He noted that this could make it harder for dermatologists and the public to identify the virus.
This is compounded by the problem of some medical equipment not working as effectively on darker skinned people. Pulse oximeters, which measure a patient’s oxygen level using light and a sensor to detect the color of blood, and which have been increasingly used during the pandemic, have been found to provide less accurate readings on skin darker. If not calibrated for darker skin tones, pigmentation could affect how light is absorbed.

“It’s not just about skin conditions,” says Ibe. “It’s just about giving everyone the value they deserve. Black, White, Asian – let’s all have the equal health care we deserve.”

A network of African medical illustrators

Although it represents one eighth of the world’s population, Africa has Less than 1% of global research output between 2012 and 2016. Even in Nigeria, images of white skin dominate the medical literature, says Ibe. Its aim is to help remedy this by creating a network of African medical illustrators.

Ibe plans to become a pediatric neurosurgeon and is also working on a textbook on birth defects in children, which will be illustrated with images of black skin.

“I want it to be a norm that whenever someone searches online for a particular skin condition, a particular health condition, that the first pop-ups are black illustrations or people of color illustrations,” he says. .

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