Opinion: ‘Textbook racism’ – we cannot tolerate intolerance in our hospitals

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‘In the case of the Pākehā North Shore patient who refused to have Asian staff involved in their surgical care, I was shocked that this request was fulfilled.’ Photo / 123rf
THREE KEY FACTS
Dr Nina Su is a NZ-born paediatric emergency doctor of Chinese descent. She hosts the Revolving Door Syndrome podcast.
OPINION
The recent events in a North Shore Hospital surgery confirmed for me that we are caught in a haze of ethical and moral confusion.

As
healthcare workers, increasingly we are encouraged to practise patient-centred care – a compassionate approach where we treat each person as an individual with their own needs and capabilities, and do our utmost to cater to their unique preferences of care. However, this raises an important question: what are the limitations of such care?

In the case of the Pākehā North Shore patient who refused to have Asian staff involved in their surgical care, I was shocked that this request was fulfilled.
At a time when we collectively reject racism, consider ourselves wiser than our backwards ancestors, and are attempting to embed cultural safety, how could hospital management fail to respond appropriately, when confronted with explicit racism?
I was born in New Zealand to working-class Chinese immigrant parents and grew up in Warkworth, studied hard and became a paediatric emergency doctor. On any given day, up to half of my nursing and medical colleagues are of Asian descent.
It would be laughable for any of our patients to refuse to be cared for by an Asian staff member. We are highly skilled, speak perfect English and have lived and trained in New Zealand for years.
Growing up in a Pākehā-dominant small town, I was reminded frequently by strangers and classmates of the colour of my skin and especially the shape of my eyes.
However, coming into adulthood and moving to the city, I felt that things were getting better. In the 2010s I began feeling that my culture, my existence, my history were accepted.
I noticed that people no longer yelled racial slurs at me from a drive-by or told me to “go back home”. We were becoming a country of increasing tolerance and appreciation of difference. However, I am now concerned that recent efforts to spread tolerance and dispel racism are having the opposite effect.
In my medical training, I have attended several workshops on cultural safety and implicit bias training, part of a movement commonly referred to as DEI (Diversity, Equity and Inclusion).
These have ranged in quality and points of emphasis. The courses I found most helpful included basic tīkanga training, which emphasised that everyone has implicit bias.
They showed us that bias peaks when we are stressed and overworked running on autopilot. Most importantly, they taught mindfulness skills to remember that the person in front of us is an individual, unique from the demographic they may belong to.
Contrast this with many other workshops where facilitators seemed intent on making attendees feel guilty for “white privilege” or “white fragility” and strongly emphasised ideas of anti-racism and decolonisation.
It’s worth noting here that I think it is important to critically examine the negative consequences of colonisation and its downstream effects on socioeconomic and health outcomes for indigenous peoples.
The evidence for poorer health outcomes for Māori and Pasifika is blindingly obvious; I see this daily in my job. My concern, though, is that in labelling every health disparity as a result of systemic racism we actually risk increasing racism while ignoring the most significant problem of inter-generational poverty.
I question whether the DEI framework actually achieves more diversity, equity and inclusion.
Most research on DEI initiatives is predicated on the power of the Implicit Association Test (IAT) uncovering implicit bias and showing that diversity training reduces people’s scores on the tests. The trouble is that doing a one-off IAT has never been shown to truly translate to an individual’s actual behaviour towards others.
Even worse is that your IAT score varies significantly based on the time of day, how tired you are or just random variation. I have yet to find research that actually measures changes in workplace culture and performance following DEI training.
More worryingly, there is evidence to suggest that mandatory training can increase discrimination when people are made to feel shame or guilt for their own immutable, often “white” characteristics.
This then begs the question, can we justify spending hundreds of thousands of taxpayer dollars on these courses for all our public servants if there is no known benefit, and in some cases harm?
In a public service such as Te Whatu Ora-Health New Zealand, managers are more likely to undergo mandatory diversity, equity and inclusion training. So why, when given a textbook example of racism, did management respond by perpetuating it to their own employees?
Best-case scenario, these management decisions were made out of compassion for the patient and protectionism over our Asian staff. But this is not compassion. This is patronising, condescending and at worst, an infringement on basic human rights by an employer prohibiting their employees’ ability to do their job solely based on their race. Even more concerning are the allegations people were prevented from speaking out.
This sets a dangerous precedent.
Perhaps most illuminating was the response from NZ’s most vociferous experts on social justice. Despite the increasing reports of hate crimes and violence towards Asian people, the silence has been deafening from our staunchest defenders of the DEI social justice framework.
We must remember our core values. Our compassion should not extend to racism and we cannot tolerate intolerance.
* This opinion is my own and does not reflect Te Whatu Ora-Health New Zealand.
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