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PACEs in Pediatrics

Decolonizing Healthcare Education and Practice (


Anna Tarazevich on

Author: To read Sonia Sarkar's article, please click here.

In their new book, Inflamed, doctors Rupa Marya and Raj Patel explore how colonialism makes us sick while also shaping our core beliefs about how healthcare providers should make us better. For example, Lakota elders in the book describe the forces that led to widespread prevalence of diabetes in their communities: colonizers arrived and dammed a river that traditionally fertilized a rich river valley where nutritious food and medicinal plants utilized by local peoples grew. As this ecosystem was erased, and as the impacts of erasure and assimilation took hold, the Lakota became less active and were forced to rely on the food and medicine of their oppressors, rather than their ancestors. Marya and Patel point out that skeletal evidence backs up these claims, showing a marked difference in Indigenous remains excavated before and after European invasion. However, they also point out a paradox that comes with this data, writing:

If you find yourself more convinced by studying skeletal remains than by listening to the oral histories of Indigenous people, you’re a participant in a colonial system of organizing truth. Reconstructing history through bones misses much that oral histories capture. Yet, in a colonial world, stories passed down by Indigenous elders cannot be considered true until they are validated by the empires that colonized them.

This tenet applies not only to our society writ large, but also to healthcare professionals. As physicians, the authors grapple with their own training, pointing out that modern clinical professionals are taught to be “biomedical technicians” rather than healers. Inevitably, they fall short when root causes of poor health, from structural racism to food insecurity, present themselves.

The COVID-19 pandemic and the national uprisings on race that took place in summer 2020 further exposed the shortcomings of our current paradigm for training, recruiting, and deploying healthcare workers. Coverage of the harrowing experiences that healthcare workers endured over the past two and a half years highlights not only the trauma that the pandemic inflicted on such workers as they cared for surges of critically ill patients with limited supplies and equipment; it also shows the stress caused by underpayment and overwork, divisive, politically driven policy shifts, and the disproportionate morbidity and mortality burden that low-income and BIPOC communities face. BIPOC healthcare workers, as well as frontline support staff, home care workers, and service staff, all of whom are deprioritized within the medical hierarchy, experienced additional layers of threat: racism and xenophobia inside and outside of their institutions and a compounded mental health toll. Since the pandemic began, 20 percent of healthcare workers in the US have quit their jobs, and healthcare labor shortages are now a major challenge for the sector.

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