The creator of the viral Black fetus image will have his illustrations published in a book

The interest came as a surprise to Chidiebere Ibe, the first-year Nigerian medical student who made the image, describing it as “just one of my drawings to advocate diversity in medical illustrations.”

The photo began a discussion about the lack of representation in these illustrations – images that are often found in textbooks and scientific journals to show diseases and medical procedures.

Ibe, 25, who is the future creative director of the Association of African Neurosurgeons, was invited to publish some of his illustrations in the second edition of a handbook designed to show how a range of conditions appear on darker skin.

The Mind with the Gap: A Clinical Guide to Signs and Symptoms in Black and Brown Skin was first published in 2020. Co-author Malone Mukwende, a medical student in London, wrote via email that “Chedeber’s work … reveals some of the biases that exist in medicine on in plain sight which we may not be aware of. Representation in health care is essential to ensuring that we do not allow implicit biases to get implanted in our heads.”

Ibe, who has a degree in Chemistry in Nigeria and now studies medicine in Ukraine, started medical illustrations only in 2020. He has already created images depicting anatomy and a range of conditions, such as Skin Disorder, Vitiligo, Cold Sores, Chest Infection and Spine Injuries, It’s all about black people.

The lack of illustrations of dermatology in black skin makes it difficult for medical students to diagnose, Ebe says. Mukwende hopes that together they can create a “diagram of the world” in terms of what diverse medical textbooks should look like and that “Mind the Gap” will be known as a “go-to book to represent a variety of skin tones.”

Big gap in acting

Dr. Gina Lister, MD, associate professor of dermatology at the University of California, San Francisco, describes Ebee’s illustrations as “fantastic.”

Lester is the director of the university’s Skin of Color program, which provides space for blacks, Asians, Hispanics and Indigenous people 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 particular condition would look different in darker skin, but not how the condition would appear. Lister says she’s “grateful” that people are now “actually responding, realizing it’s a big problem and making changes to address it.”

Chidiebere Ibe began creating medical illustrations in 2020, depicting a range of conditions and anatomy, all in black.

“I think it is important to increase representation across the board because… who knows what this young mind inspires when they see themselves represented in this way, and who might be inspired to go into science or become a doctor or nurse or something, by seeing themselves photographers 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 the more than 6,000 gender-specific images published between 2008 and 2013 in 17 textbooks, the vast majority were white and just over a third were white. feminine. About 3% showed disabled bodies and 2% of the elderly.

Covid-19 has exposed disparities in healthcare

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

“Covid-19 has brought to light a lot of issues of disparities, and that has prompted us to think about disparities and all the ways in which they manifest, including with skin conditions,” Lister says.

The vast majority of pictures in anatomy textbooks are of white people.  Ebe is working on a textbook on birth defects in children, which he says will be illustrated with pictures of black skin.
Lister co-authored a research letter published in the British Journal of Dermatology in May 2020 that found that scientific articles describing cutaneous manifestations of Covid-19 “almost exclusively display (ed.) brown skin She noted that this could make it difficult for dermatologists and the public to identify the virus.
This is exacerbated by the problem of some medical equipment not working effectively on people with darker skin. 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 darker skin. If not calibrated for darker skin tones, pigmentation may affect how light is absorbed.

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

A network of African medical illustrators

Although Africa makes up one-eighth of the world’s population, it accounted for less than 1% of global research output between 2012 and 2016. Even in Nigeria, images of white skin dominate the medical literature, Ibe says. His goal 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 pictures of black skin.

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

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