Bianca Ituarte
M2, UMKC School of Medicine
“But dad no you’re not American, because Mexicans are brown like you and Americans are pink like me” This is a phrase I commonly told my dad as a toddler. His story is the classic Mexican immigrant coming to the US as a teenager with only the clothes on his back. Even today there are many trials and tribulations of which I will never have a complete understanding. But my story begins after he met my mom in law school. Since he was just my dad, I never thought much of the fact that he was the only Latino professional I saw in my youth and a trailblazer on his own.
I was hesitant to write anything for the LMSA journal because what new hot takes are going to come from a white latina? Growing up mixed comes with a pre-packaged sense of otherness, but I cannot waste time lamenting on the feelings of ethinic imposter syndrome better articulated by more qualified authors. Being a young child in the city of St. Louis exposed me to the glaring inequalities and evils of racism before I could ride a bike.
The major catalyst for writing this at all is the recent incident of my younger brother being profiled at his college campus and intimidated by the university police. Like countless others, we were given “the talk” around the kitchen table regarding the way we will forever move through society. My siblings are much more phenotypically recognizable as Latinos and at the ripe age of elementary school learned how to keep their hands on the wheel in a traffic stop and move in a non-intimidating manner in public.
Fast forward to college at a combined college/medical school program. For the first time in my life I was surrounded in the lecture hall by a plethora of kids who grew up 30 miles away from me, yet simultaneously in a completely different world. Back in high school we would often joke about these same suburbanites too scared to step foot in city limits unless for a photo op at the baseball stadium. Now, these are my peers and the next generation of physicians. I quickly got over my predisposed expectations from the sheltered kids and made some amazing friends and colleagues along the way, but there still remains a sense of otherness.
Latinos are underrepresented in medicine– not a big shock. What became alarming however, was the blasé attitude from non-URM students about this disparity. “Since Latinos are the largest growing minority group, surely it makes sense that professions mirror these demographics being served at our hospital institutions?” This is not a topic I thought I would have to be debating with other medical students, and at the very least not those working with a Hispanic population in a metropolitan area.
One of the major pros to my program is the clinical exposure from day one. It is a blessing to have the chance to learn interview skills as a college freshman, but over the past four years I have heard every combination of racial stereotype and “affirmative action” as ways of downplaying Latinx and Black accomplishments- from patients and medical personnel alike. People will say the most asinine and vile things when they think you are in on their joke. People (students to attendings) won’t “clock me” as Latina right away and let free the ignorant and hateful comments with the expectation that I will agree and laugh along. The scariest part is the fact that most of the time they’re not being said with a hateful tone, but rather with the tone of a widely understood truth.
“I don’t want that patient on our [inpatient] team, she sounds like she’ll need a translator. Looking at her chart she’s a frequent flier and we’re not going to do anything new this time anyways on her.”
“Ugh, one of those dialysis patients admitted from the emergency room again? Really it’s going to be such a waste of my time writing this discharge summary, it’s not even like he has papers–the hospital loses so much money on these people coming in every few days.”
“This is her third baby and she’s how old again? Honestly she needs a punch card for this place or something if she’s going to keep having babies at this rate.”
I wish I could say these comments were the most egregious I’ve heard over my training, but rather these are just collected over the past 6 months. As much as possible I corrected the comments right away with something as simple as, “Wait what did you mean by that? I’m not sure I caught that the first time around.” and this made the student or resident backtrack and apologize. This by no means cures the problem, but at least the patient and their family won’t be subjected to hearing these comments when in their vulnerable states.
Unfortunately, I’ve been illegally used as an interpreter on every clinical rotation thus far by the same doctors saying the above comments. I make it very clear with the physician that I am not certified and it is not a part of the medical student workload, but this is a hard conversation to have when the person dangles your grade on a string with the threat of docking points for not speeding up the clinic visit. However, I have been known to dig my heels into the ground by already having set up for the interpreter as soon as the patient checks in at the front desk and report them on the back end.
With the support and hard work of our DEI office, URM students have been able to make tremendous strides in the right direction towards medical equity and learning. Over the past few years, we’ve implemented pipeline programs, secured scholarships for M2s prepping for their boards, and added mandatory anti-racism curriculum. However, it can feel like one step forward two steps back when signing off of a productive zoom meeting and hearing these comments the next day on rounds.
This is where the mixed privilege and responsibility comes into play. We have a unique position in this society that allows us unfiltered access to the inner workings of people’s thoughts. When people don’t expect to sit up straight and put on their best behavior, you’re really able to get a sense of how they really feel about their students and patients. Individual behaviors can’t solve the structural issue that is the lack of representation at the top, but we can chip away at the biases still rampant in medical training. In fact, we have the responsibility to take some of the burden off of our Black and Brown families by acting as agents of change whenever presented with the opportunity.
I feel many emotions as I write this- anger, fear, hopelessness for my brother. But more so than anything I feel proud and hopeful to be a part of the next generation of physicians with the opportunity to serve patients in the same way I wish my family was treated when they arrived in this country 40 years ago. Latinos are not going away anytime soon. Ultimately, increasing the number of us making it through training can eventually change the cultural attitudes, but until then I will continue to encourage all mixed and non-URM students to speak up.
About the author: Bianca Ituarte is a 4th Year (M2) in the UMKC 6 Year BA/MD program. She has Mexican roots and is passionate about increasing all facets of diversity in medicine. She would like to thank the UMKC SOM DEI office and student organizations for their hard work and dedication to this matter. Outside of school you can catch her chasing her cat Chamomile around the house.
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