Medical student creates handbook to show symptoms on darker skin

A second-year medical student has written a book to help medics recognise symptoms on Black and Asian skin tones.

Malone Mukwende, who is studying at St George’s, University of London wrote Mind The Gap after he “noticed a lack of teaching about darker skin”.

“We were often taught to look for symptoms, such as rashes, in a way that I knew wouldn’t appear on my own skin,” he says.

The British Medical Journal explains: “Mind the Gap is a handbook of clinical signs in black and brown skin. Its aim is to teach medical students and other health professionals about the importance of recognising how some conditions can present differently in darker skins.”

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The book contains images showing how illnesses appear on both light and darker skin. It also includes suggestions for phrases and language that is appropriate for doctors to use with their patient.

Malone said the coronavirus pandemic had exacerbated problems with coronavirus patients being asked if they are “pale” or if their lips “turned blue”.

“These are not useful descriptors for a black patient and, as a result, their care is compromised from the first point of contact”, the St George’s website stated.

St George’s has backed the handbook and helped Malone to connect with a team of lecturers who helped him to publish the book. A university spokesperson said: “It was agreed that this was a very important issue and an essential part of decolonizing the curriculum.”

Mind the Gap comes after a petition urging medical schools to include BAME representation in clinical teaching reached over 190,000 signatures. The petition stated “white normativity in medical teaching means that medical students are often unprepared in recognising signs of certain diseases in BAME students that do not present in the same way as white patients and/or are not as clinically obvious”.

Kawasaki disease has been used as an example to show how the symptoms differ between white and black and brown skin.

On white skin, a clear red rash can be identified as a symptom of the disease whilst it is much harder to see on darker skin.

Tash, a second-year medical student, told The Tab: “The majority of pictures I have been shown are of people with fair skin, especially for common conditions such as eczema and psoriasis.”

Tash added medical students were “very rarely” shown symptoms on black and brown skin.

“By not being taught how to recognise dermatological conditions in patients of all ethnicities, it may lead to missing key signs and symptoms that could ultimately lead to an important diagnosis”, she said.

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