Thick Skin and the Colour of Pain

A Familiar Ethnicity Pain Gap

It comes as no surprise to me to read that in the UK, women from Bangladeshi, Pakistani, and black Caribbean backgrounds were less likely than white women to receive an epidural whilst having a vaginal birth. [The Guardian: “Women from minority backgrounds in UK less likely to receive epidurals, research finds”]

The ideas, conceptions, perceptions, or prejudices that feed the narrative that non-white people, especially from the aforementioned backgrounds, do not need adequate pain medication to arrest high levels of discomfort and distress have appeared in studies for decades.

This situation, termed the "ethnicity pain gap", is quite concerning, and it might persuade one to surmise that there is a seething racialised disadvantage in the public health system, one that ascribes thick skin to the Black population and precious delicateness to the Asian cohort.

My Own Experience

My experience of this in late 2009 came as a result of cancer pain in its enduring intensity. I was on multiple regimens of pain medication, with Fentanyl dispensed as a transdermal patch being the most critical palliative, yet I was in pain.

When I informed my consultant that I was still in pain, and this was in the Netherlands rather than in the United Kingdom, he did not acknowledge my distress or seek to address it. Instead, his response was that the pain medication I was on should be enough. An ill-informed perception that I should have a higher pain threshold.

I remonstrated that it was not, and he then sought to double the dose from 12.5 micrograms to 25 micrograms. This made all the difference because it tackled the pain, and I got much-needed relief. Why I was not also told that transdermal patches could fall off, and that they could be held in place on the skin with an adhesive film, escapes me.

Knowledge Withheld

Returning from church, one Sunday, a few weeks after I had the new prescription, I was in a lot more pain than usual, and then I saw that the patch had fallen off.

I laughed myself to delirium to produce endorphins as pain relief whilst the new patch took hold. It was only when I told the nurse who came to dress the lesions on my foot daily that he told me I could get an adhesive film to keep the patch in place.

The knowledge was there all along, but it was never shared. As a race, in our encounters with the medical establishment, we are constantly pathologised, and this is characterised by either not being listened to or being ignored, because the medical personnel assume they know and understand our bodies more than we do with the intimate experience of our own skins.

Asserting Our Reality

That Caucasians are immediately responded to and given palliative succour on demand speaks volumes, without suggesting something untoward. Whether it is bias, prejudice, or indifference, we need to be better equipped to ask pertinent questions and persuade our doctors of our reality, without having to jump through hoops, trapped in suffering until it becomes unbearable.

It is not just in matters of pain, but in decisions being made about diagnostic and treatment regimes without explanation or rationale, delay in action when the full knowledge of a condition is evident, the lack of respect, courtesy, and the according of dignity to your personhood and humanity, or the use of the wrong indicators based on race for decision trees towards useful outcomes.

I approach the medical establishment on the premise of “It is my body first, before it is your guinea pig.” This need never be the default, because you are then preparing for a fight instead of fully trusting someone who took the Hippocratic Oath to do you no harm. Yet you find you need to assert yourself and manage the egos to ensure that you, at the very least, leave the hospital better than when you went in.

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