'What racism does, many, many times, is remove your voice'

By Louise Kinross

A memorial for George Floyd took place today in Minneapolis, after 10 days of global protest against police violence and racism. Yesterday, Dr. Sharon Smile, a developmental pediatrician at Holland Bloorview, wrote a message to our doctors titled “Making Change Together,” which began: “It has been challenging as a person of colour and visible minority to view what is happening in the world in 2020.” Sharon is taking on a new role as Equity, Diversity and Inclusion (EDI) Champion with the University of Toronto's Department of Pediatrics. We spoke about her experiences as a black doctor, and her invitation to our doctors to take part in “uncomfortable discussions about racism and how it impacts us as a unit and the families and clients that we see at our hospital...”

BLOOM: You wrote in your message to doctors: ‘It is hard to speak about hate when you are constantly its recipient.’ What is your experience?

Sharon Smile: It's hard to single out an experience because my life experience is molded by it. As a physician, you're judged by your outward appearance, and stereotypes or labels are assigned to us, with or without our consent, and we're judged by those stereotypes. Racism is a social construct that impacts people's beliefs and attitudes and actions, and results in people with a certain phenotype or heritage or culture having unequal opportunities.

My experience is that I am always trying to explain myself: You're not allowed to make a mistake, you're not allowed to have an opinion that might be outside of societal norms, because you have a label. You are constantly auto-correcting.

You're always at a perceived disadvantage, so you have to be cautious. You don't have the freedom of being who you truly are, without being penalized for that.

BLOOM: We've talked before about racism in health care, but you weren't ready to speak about it publicly.

Sharon Smile: The pain broke my silence. I did a lot of self reflection with what's happening in the world right now and I said to myself, 'Okay, you do the right things. You constantly do the right things. You're a law-abiding citizen. You try to see the good in everyone. You try to ensure that your attitudes to all are for the betterment of humanity as a whole. But still... It happens. Yet still... it happens. Again and again and again.

It's that constant auto-correcting, to the point where at some point you don't have any more to correct. It's the hopelessness when I watch what's happening in the world, and I hear from parents or patients who experienced this in their own communities, prior to the recent events. It's as if we had a voice, and we lost our voices through racism.

This hopelessness and frustration is what you see coming through the news right now, and it's the reason there are these demonstrations. It's happening again, and what are we doing about it? For me, speaking out is part of that solution. I have to address what is happening, and to not experience racism in silence. Because we know how to do that very well—we've learned that in childhood and into adolescence and adulthood.

We're judged by a yardstick that is a construct created by others to oppress, and it's accepted in many realms, or ignored or not acknowledged. People ask me: 'What's the solution?' The first thing that comes to my mind, and it's a gut response, is a mirror. Look in the mirror. That's the solution. And it's not for a particular group, it's for everyone. It leads me to that personal responsibility to speak out, and not let my narrative be written for me by others.

BLOOM: Dr. Naheed Dosani, who is a local palliative care doctor who works with homeless people, tweeted: “Given racism is literally killing people in our communities, it is alarming how little we talk about it in medicine.” Why is that?

Sharon Smile: Because it's hard to talk about it. For some it's a very concrete concept—something they live and experience. For others it's abstract, something that happens on the news, to others.

In medicine itself, why is it not spoken about? We would have to ask our leaders in medicine. Sometimes it's because our leaders cannot relate to it. It's not part of their story.

When we talk about racism, it's not a discussion about blaming others. Acknowledgement is important. The solution requires all. We need to self reflect: How are my biases impacting this? Have I witnessed racism, and what was my response? Was I more of an ally, or an observer? We need to stop being observers, and be allies for change.

BLOOM: How does racism impact a child’s development?

Sharon Smile: There's a lot of research coming out, and the American Academy of Pediatrics has labelled racism a socially transmittable disease.

When we look at child health, racism is one of the social determinants of health—the conditions people are born into, or grow up with, that influence how they develop. Social determinants of health include poverty and housing insecurity and nutrition.

We do know that racism can impact development in very negative ways, especially for victims of chronic racial trauma. It can impact on mental health, causing depression, anxiety, and poor self-esteem.

Racism is associated with the number of kids we see in our legal system, and who have conduct problems in school. Because it's a chronic state, it also impacts us at a chemical, cellular level. It increases our cortisol level which, over time, is associated with chronic illnesses.

If a child is a victim of racism, then probably the family are also victims of racism. Families deal with it in many different ways.

One family may be very open about it, and talk about their responses to it, and the child may borrow those strategies and use them in their own lives.

However, there are other families who may be silent, like many of us, and deal with it internally, as opposed to externally. That doesn't equip the child with the tools to deal with racism when they're faced with it in the home environment or community.

BLOOM: I heard Trevor Noah talk about how our society is built on a social contract, but that contract, which includes equal opportunity, has been broken for racialized people, over and over again. It was a way of understanding some of the violent protests.

Sharon Smile: What racism does, many, many times, is remove your voice. If you've been speaking, and there's no response, it's like a child who is non-verbal, trying to communicate. If a non-verbal child resorts to certain behaviours, we try to understand what that child is experiencing and thinking, and what the intent is behind their actions.

When we look at these demonstrations, we see people saying 'I've used my voice, and nothing happened. I've tried to be an ally with you, and nothing happened. I've tried to build with you, because we are one, and nothing is happening.'

When we come out in numbers, or when there is destruction, or when we do something to hurt the economy, these behaviours are acknowledged. When we see these behaviours, one should stop, look and ask why?

If you look at why racism was created, then you realize I'm part of this, and to deconstruct it will require every human on the planet.

BLOOM: What do you hear from clients and families about racism?

Sharon Smile: It could be as simple as the way someone looks at them, because they're linking them to a stereotype that can limit their access to health-care services, or academic supports, or housing.

Parents try to explain to their child with a disability that they are also a visible minority. That term—visible minority—is in itself challenging, because minority means 'less than.' These labels we keep putting on groups are challenging to explain to a child. Then that child becomes an adolescent who questions: 'Why are you calling me that? Why are you labelling me this way?' And we truly don't have a good answer for that.

BLOOM: I'm aware of language used to describe disability that implies a person is 'less than.' But I never thought of the word 'minority' in that context.

Sharon Smile: It's not about blame-gaming, but listening to language, because words are powerful, especially when you're voiceless in situations, or overlooked. If you go to a Grade 3 class and ask 'What does minority mean?' they'll say 'The opposite of majority.'

BLOOM: Okay, so I see this is a way of 'othering' or separating someone from the majority, in a way that implies they have less value.

Sharon Smile: This construct of racism places people in categories and labels them and says 'This is who you are,' as opposed to allowing them to learn who they are, and allowing them the luxury you have to discover and rediscover who you are.

Racism assigns a value to colour, to occupation, to your journey to economic independence. Why was this construct created? We have to go back to the history that happened 500 years ago.

BLOOM: To slavery.

Sharon Smile: It's hard to talk about. It's like when people tell Indigenous people: 'We've spoken about [colonialism] already.'

It's a hard thing to see and acknowledge how we have hurt each other, and to accept that we're a part of it, it's a part of our heritage. When we talk about Canadian history in school, sometimes we change the narrative, or remove it, to make it more comfortable.

BLOOM: What do you hear from staff about being on the receiving end of racism?

Sharon Smile: I'm going to tell you truthfully, it's like this silent acknowledgement that it happens. We know it happens, but you have to auto-correct. It ruffles your feathers, but you smooth them out and keep going. It's difficult to stop, every day, every hour, to grieve.

Racism is a system that eats from within. Our life journey is finding strategies to cope with experiences that are not necessarily acknowledged, or only acknowledged when there's an uproar on the news. Racism is a concept that can be abstract to many. It's in a TV program, it's not happening here. It's in the street, or in the poor cities in the United States. But I am, and anyone can be, victims of racism.

As the new EDI rep, I'm hoping to have a safe space where staff can debrief and there can be an acknowledgment and then go to the next step of what we can do about it.

Our organization is opening up to a conversation about racism. This is led by our Equity Diversity and Inclusion Lead Meenu Sikand. We need to acknowledge that racism exists in health institutions, and is not limited to staff, but also to our families and clients. We need to raise awareness of racism as being a social determinant of health that is pervasive in our community.

BLOOM: How can staff better support families who are oppressed because of skin colour?

Sharon Smile: We usually refer families to our social workers, who try to access community supports for families. There's an absence in our health-care and medical curriculums on how to address racism, and there needs to be something more systematic and standardized.

We need people who are able to counsel persons who are victims of racism, and delve into which strategies and avenues can address what's happening, so that it doesn't happen again. This requires ongoing intervention, as opposed to 'read this book,' or 'go to this website.'

BLOOM: Should we have those supports internally?

Sharon Smile: I think this is where the discussion is going to lead, but it's a question of coming up with meaningful and scalable strategies, which may include having mental health supports.

It starts out with education, and ensuring every staff, student and volunteer, as part of their introduction to Holland Bloorview, goes through an anti-racism module.

We also need the language, in our communications to families, to show that we're invested in being a safe place, and we're part of the discussion to eradicate racism. Because it does need to be eradicated.