Born in the United States of America to Nigerian parents, I was raised in Nigeria and returned to the U.S. after medical school for residency training. I have practiced medicine in Chicago, IL for 25 years, and like many others, have had to deal with microaggressions and racism within and outside the workplace. However, this article is not aheabout outlining my personal experiences. This is a call to action to my fellow Black colleagues born or raised in Africa and now living in the U.S. We have to understand and acknowledge that we are beneficiaries of opportunities and rights that many fought and died for.

A recent study from the Migration Policy Institute showed that among the 958,000 physicians in the U.S., 269,000 (28 percent) were immigrants. Of the 21,000 African born physicians, 6,000 (28 percent) are from Nigeria. We own practices, are in leadership positions, have expansive networks, and our voices are needed. Our colleagues, our patients, the Black community needs us to be an active voice in the fight to dismantle systemic racism.

You may have heard the statement, “Compound interest is your friend when you save/invest and your worst enemy when you owe.” Compound interest stacks on, and every month you have a higher new baseline. The critical importance and impact of time on this trajectory are why I encourage young people to start saving/investing early. It’s why I am the “boring aunt” whose birthday gifts to my nephews and nieces are checks for savings/college funds and not fancy toys or gadgets. I think about micro and macro aggressions in that same way. Like compound interest, they stack on, grow, expand, and are not simply additive. Over time, the cumulative effect of microaggressions and overt racism can adversely affect self-confidence, esteem, mental and physical health. This stress can prime an individual to constantly be in a “fight or flight” state. This is tiring and makes the soul weary. Consider a recent JAMA article: “As a child, racism makes you feel lost and afraid; as a young adult, racism leaves you on the outside looking in; as a young aspiring professional, racism makes you start at the back, work twice as hard, for half as much; and as a mature adult, racism makes your soul grieve.”

While African born Blacks are not immune to these micro-aggressions, we were spared from them during those critical early years of identity development. A Nigerian friend who is a top executive in the U.S. stated it best in a recent post, “Growing up without the overhang of racism is one of the biggest advantages I have had.” Many of our Black colleagues and Black patients have had a lifetime of living with the overhang of racism. We must recognize our privilege and do more to support our fellow physician colleagues and the larger Black community. It is our fight too. It took me a while to fully understand that, and I took deliberate, intentional steps to educate myself and learn from others.

Here are five things we can do now as we play our part in dismantling systemic racism in health care and other institutions.

1. Learn about the history of the U.S. and the struggles of Blacks in America. Read Black authors and do a deep dive into American history. (Audiobooks and podcasts work too for busy doctors.)

2. Seek to understand and explore diverse viewpoints and lived experiences. Listen to your American born Black colleagues. Listen and learn from your Black patients. This will mean stepping out of your comfort zone. This will help us better understand the struggles and challenges our colleagues and the patients we serve have faced for decades.

3. Discuss race and the role it plays in our society with your children and learn from them. I have learned a lot from mine who have lived their entire lives in the U.S.

4. Stop casually accepting that you are a ”special Black” or “different from the others,” “the exception“ at work, or in your other networks. Seek to educate and inform. Be a part of the solution to enhancing diversity in the pipeline and leadership.

5. Invest your 3 Ts: time, talent, and treasures as you do your part in dismantling systemic racism in and outside of the workplace. Use your position, influence, and networks to advocate for change. Mentor, empower, be an advocate for your patients, a healer, donate to organizations working for social justice, vote, run for office, and continue to speak up.

We, the Black immigrant physicians, have to continue to speak up in the fight for equality and stand against injustice. Our colleagues need us. Our patients need us. The Black community needs us. It is our fight too. Silence is not acceptable. Silence is not OK. It is time for change, and it’s all hands (voices) on deck.

Toyin M. Falusi is an infectious disease physician.

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