Mediterranean Syndrome

Women of Color in Peace, Security and Conflict Transformation The Race Across the Pond Initiative: Women of Color in the Healthcare System Series

probably referred to white skins as standards and did not consider skin color as a measurement bias factor. Additionally, in the three types of oximeters tested in this study (Nonin, Novametrix, Nellcor) the data confirm important bias between skin pigmentation, with bias ranging from 4 to 8% for dark-skinned subjects.

Likewise, the COVID-19 pandemic has helped focus attention on hypoxia, one of the severity symptoms. Sjoding et al. released a study in 2020 alerting to the increased risk incurred by Black people and people of color with dark skin, in connection with the biases generated by these devices.

Of course, the overexposure of racialized groups to COVID is multi-causal. However, it is urgent we question the use of some medical devices that have been identified as biased and potentially dangerous for RMGs and wonder if these devices have not contributed to the worsening of, and potentially the death from the disease among these communities. The oximeters, which tend to mask hypoxia of black people while it is a factor in the aggravation of the disease, is a blatant example.

4. RACISM, DISCRIMINATION, AND STEREOTYPES IN MEDICAL PRACTICES AND PATIENT CARE: THE MEDITERRANEAN SYNDROM

Ranging from false beliefs, conscious and unconscious bias, limited intercultural skills, and sensitivity to diversity, racism, discrimination and stereotypes in medical practices and patient care are serious problems.

The case of pain interpretation is best illustrated through the Mediterranean Syndrome, a set of racial stereotypes used by health care staff in the French medical field who consider that people with North African heritage tend to exaggerate their symptoms and pain. Today, the use of Mediterranean syndrome is broadened to also encompass sub-Saharan African patients. 7 This false “syndrome” is in theory not officially taught (explicitly) in the medical and paramedical courses, but is rather transmitted during on the ground internships and professional experiences.

It is largely through practice in the professional environment that health workers acquire these social and racial representations. Social representation can be defined as "a form of knowledge, socially developed and shared, having a practical aim and contributing to the construction of a reality common to a social whole." (Jodelet, D. 1989). Thus, health professionals’ common values inherent to care, along with more or less grounded beliefs, as well as their own mental projections, impact their professional practices. The

7 Vega, A. (2012). “Soignants, SOIGNÉS: Pour une approche anthropologique Des soins infirmiers.” De Boeck.

Women of Color in Peace, Security and Conflict Transformation The Race Across the Pond Initiative: Women of Color in the Healthcare System Series

negligence of pain in the name of the racist cultural stereotypes called Mediterranean Syndrome is an outcome of these beliefs and projections.

The genesis of this belief comes from the French colonial medicine period and extends to the North African and Sub-Saharan migration waves of the 1970s. French medicine and psychiatry were left lost in front of migrant patients complaining about pains they considered “unknown.”8 Health professionals started referring to this phenomenon as “coulchite” (pain everywhere) or “North-African Syndrome.”8 By negatively naming, stereotyping, dehumanizing, and discriminating against misunderstood pains, while wrongly using a medical lexical language (syndrome), they intended to transfer the incapacity and responsibility of the doctors from the health staffs to the patients themselves, reflecting the circumvention of “the incomprehension [or] even the discomfort of health professionals” (S, Savas. 2009). Although the use of the expression of Mediterranean Syndrome has become quite obsolete in the healthcare field, its theory and practical use - whether consciously or unconsciously - are still very much topical in professional health care circles until this day.

Official figures on the number of healthcare workers familiar with the Mediterranean Syndrome are lacking. However, racist and discriminating practices linked to the use of these stereotypes keep circulating and remain anchored in the practices of the medical sector, in hospital environments or in private facilities. As part of a thesis carried out in 2020 in the emergency services of the Alsace region, out of the 69 doctors who were questioned about the Mediterranean syndrome 88% said they were familiar with this term and concept and 75% witnessed its practice by a peer. Findings of an independent NGO study that measures the extent of discrimination in the medical system also reveal that 28% of respondents received racist or sexists comments during medical care. Although results should be taken with precaution due to the sample not being representative enough of the French population, the study gives an insight to the existence of a set of behaviors, prejudices, and racial and racist stereotypes in the medical system. This set negatively influences, directly and indirectly, the care and the health of RMGs in France.

This impact of the Mediterranean Syndrome is far from trivial and can lead to dramatic consequences as in the case of Naomi Musenga. In 2017 this young black woman from Strasbourg died from severe abdominal pain after calling the SAMU du Bas Rhin (equiv. calling 911) for an ambulance. The SAMU telephone operators did not pay attention to

8 F. Fanon. (2001). “Le « syndrome nord-africain. » “ Pour la révolution africaine, Écrits politiques, Paris, La

Découverte.

Women of Color in Peace, Security and Conflict Transformation The Race Across the Pond Initiative: Women of Color in the Healthcare System Series

her distressed call, openly mocked her, and hung up on her. A few hours later, the young woman died without ever accessing help. This case stunned the French society. Many French organizations, doctors, and the media denounced the role of the Mediterranean syndrome in Naomi Musenga’s death.

In the era of social and digital networks, concerned individuals have mobilized in recent years to tackle these injustices, lift the voice of RMGs’ individual and collective experiences, and fight against discrimination and cognitive biases. The scientific literature, for its part, has an excessive delay catching up in this field and still remains largely underdeveloped.