In the News

My Patients Don’t Care I’m from a “Shithole” Country: Guest Opinion

March 8, 2018

Column originally published on OregonLive, the website of The Oregonian, March 8, 2018.

By Dr. Rahel Nardos

When I first learned how the president described us, me and my fellow immigrants from Africa, my first reaction was not anger or surprise. Rather, I was saddened by how others in the room with him, and those outside, like myself, enabled this through our collective silence.

So I can either continue to partner with the president through my silence, or I can tell my story. A few recent incidents at work have opened my eyes to our current reality: Even when you achieve the highest academic or economic standards, you aren’t protected from racial bias.

The first incident was a couple of months ago. I had just finished examining my patient when her husband asked me where I was from. I get asked that question a lot and struggle to find the right answer.

I grew up in Ethiopia until I was 18, then I came to the U.S. on a college scholarship. I have now lived in America for 25 years. Through my educational journey, including an Ivy League medical education, Americans have believed that I add value to their institutions. I identify with my American way of life as much as I do with my Ethiopian heritage. I have now lived in four different states and am just beginning to feel that Portland could be my home.

So I told my patient’s husband, a retired Portland Police chief, that I am originally from Ethiopia, a country in Africa but I am also an American. He couldn’t hide his surprise. “I thought you were from an island nation,” he said, “You don’t look like the typical negro I am used to seeing. You are too good looking.”

I was shocked to hear this. I wondered how this interaction would have gone if I’d looked more like the “negros” he had in mind? Would I have been good enough to care for his wife? My reflex was to educate him about Africans, how we are not from one country and that we come in different colors, cultures, languages.

I walked out of the room, my heart racing. Even the most difficult surgery I’ve done in my last seven years hadn’t rattled me that much.

Later, I realized something good may have come from this. I may have shaken his perception of an “African.” He’ll have to reconcile that someone can be an African, a female surgeon and also meet his standard of beauty. The more we interact with people like my patient’s husband, the more we are likely to change these biases. We need to be visible. When President Obama was in office, my son’s 6-year-old friend told his parents he wanted to be an American like my son. Confused, they told him he already was an American. “No!” he replied. He wanted to be black like my son so he could be an American. In his mind, to be an American was to look like the president.

The second incident was a few weeks ago, when a patient was given an appointment with my Iranian American colleague. The patient didn’t like the sound of her name. She was then offered an appointment with me. She did not like how my name sounded, either. She insisted on seeing an “American doctor” to which my staff responded that we are all Americans. She wanted a white doctor, born in America. She got one.

My staff has been trained to provide patient-centered care, but they haven’t been given the tools to know when and how to draw the line. This incident saddened me as I’ve put in four years of college, four years of medical school, four years of residency training and three years of fellowship so that I can provide the care for my patients that I would want for myself and my family. The patient couldn’t tell from my name that I have the most years of experience in our office and have trained many of those “white” doctors she prefers.

Despite these incidents, the real story I wanted to tell is that when I’m in a room with my patients, listening to their distressed voices or when they trust me with their lives in the operating room, they do not care that I’m from a “shithole” country. I know this because I hear the words “I trust you, doctor,” multiple times a day. And, my office is overflowing with thank-you cards.

Being an immigrant has given me enough outsider perspective to understand that I don’t always know what is best for the patient. When I start from that place, it forces me to listen to what matters to them. When you earn their trust that way, they don’t notice or care whether you are black or white.

Dr. Rahel Nardos is the lead urogynecologist at Kaiser Permanente NW in Portland; at OHSU, she is an assistant professor in the division of Pelvic Medicine and Reconstructive Pelvic Surgery and director of Global Health in Obstetrics and Gynecology. The opinions expressed here are her own.