By Moyo Lawuyi
Listen to an audio version of the story below:
He seemed to be doing something. The last one had sent her home with empty, reassuring words. This one, at least, started opening the blood pressure monitor on his desk after she told him what was wrong. The fluorescent lights in his office at the walk-in clinic in Brampton blinked and buzzed, like how Tolu felt when the blood pressure pump became the only sound in the room. Her mind, however, was nothing like this. It echoed with a million things the doctor could possibly say when he was done.
Tolu was 17, and this was the second doctor she had seen for the same problem. Her periods were irregular, always lasting for a month and leaving her fatigued from the heavy blood loss. She had come for a solution or, at least clarity from a professional. Instead, the doctor broke the silence by dropping the blame on her. “You are not even taking your iron pills. It’s your fault you are feeling this way, and you’re not doing anything about it,” she remembers him saying as he unstrapped the velcro band from her arm. When she tried to tell him that her pills weren’t helping, he dismissed her.
Tolu would visit one more doctor, this time in Scarborough, and would also feel not listened to. Inevitably, self-doubt crept into her mind; maybe she was doing too much, wasting people’s time. But she saw firsthand that this wasn’t true when her next period lasted for three months. “I couldn’t take this anymore,” she said. Coincidentally, she was travelling to Nigeria that December and decided not to return from her home country without answers. In December 2023, after a year of trying, Tolu was diagnosed with Polycystic Ovary Syndrome.
The World Health Organisation says PCOS is a hormonal disorder common amongst 8 per cent to 13 per cent of reproductive-aged women in the world, and as of 2017, 1.4 million women in Canada have this condition. Still, cases like Tolu show how difficult it could be to get a diagnosis as a Black woman, even in the most diverse of places.
In 2020, the Toronto Board of Health declared Anti-Black racism a public health crisis, acknowledging the systemic racism that prevents people of African descent from getting equal treatment and access to healthcare in the city.
Despite finally getting closure, Tolu couldn’t help but question why no one took her seriously in Toronto. “Maybe my race had also affected it because it had happened with three doctors. It was really starting to get frustrating and questionable,” she said.
Anti-Black medical racism can show up in the form of stereotyping and provider bias. However, it is also a systemic issue, and according to the Canadian Medical Journal, the lower socioeconomic status, which many Black Canadians have, results in poorer health outcomes. This was the case during the COVID-19 Pandemic when Black Canadians were reported most likely to be affected. Similarly, in Toronto, Black people made up 21 per cent of coronavirus cases despite being only 9 per cent of the population.
But, Dr. Modupe Tunde-Byass, the President of the Black Physicians of Canada, says the health disparities are not biological. “The racism itself is the problem, not the race,” she said. In other words, experiencing both explicit and systemic racism for so long can lead to stress, lack of sleep and mental health issues that adversely affect one’s health.
Black women experience disproportionate rates of fibroids, maternal mortality, and breast cancer-related deaths. They are also affected disproportionately by PCOS symptoms, having higher rates of obesity, insulin resistance, and hirsutism (excess hair growth).
In 2017, Jamaican-Canadian Leah Ennis was lying on the reclining chair for her appointment when her wax lady leaned over and told her she had excess hair going down from her face to her neck. She had also struggled with labelling what would later be identified as feelings of anxiety and depression. So she decided to go to her family doctor.
A man she was familiar with would spin around in his office chair, looking at her through his thin, clear glasses, and tell her the hair on her chin was genetic. Ennis, however, had been hairier than average since she was a child, and she knew the hair on her face was not this. She asked him if it could be a hormonal thing like she had researched, and he shook his head.
“It didn’t feel like he was concerned. It didn’t feel like he was listening,”
Leah Ennis
She managed to get a referral to an endocrinologist who performed an ultrasound and bloodwork on her, which would get her diagnosed with PCOS. But even after receiving her diagnosis, she would still not feel comfortable in the traditional medical space.
Another day in a doctor’s office in North York, Ennis lay on a metal table waiting for the physician to enter the room. Seeing a woman come in made Ennis feel a bit better about having her legs up. But the interaction felt like the doctor was clocking in and out of a job she didn’t like. Leah thought she was barely acknowledged or cared for, especially since she was, and felt, vulnerable.
Because Anti-Black racism is systemic, Dr. Tunde-Byass doesn’t believe firing biased healthcare workers would make much of a difference. The question of how to actually effect this change remains difficult to answer.
Unlike the United Kingdom and the United States, Canada fails to collect enough race-based health care data. The Ontario Government just started doing so in 2020. According to Dr. Tunde Byass, this is a huge problem as it creates the illusion that systemic racism in Canadian healthcare doesn’t exist. “We probably would not have known about the COVID-19 disparities if we had not collected race-based data,” she said.
She also believes the Canadian government’s infatuation with the country’s diversity doesn’t allow it to recognize Canada’s history with Black people in healthcare and how it still affects them today.
In 1918, Queen’s University Medical School banned Black students from attending. Although it stopped being enforced after 1965, the ban remained on the books until 2018, and the institution didn’t issue an official apology until 2019. The University of Toronto and McGill University also imposed bans on Black medical students in the early 20th century.
Dr. Tunde-Byass says that moments like these were the beginnings of Black underrepresentation in Canadian healthcare that exists today.
In Ontario, 4.5 per cent of the population is Black, but Black physicians only make up 2.3 per cent of practitioners.
Tolu sometimes thinks her experience would have been different if she had seen a Black doctor. “This would be someone that looks like me and understands the struggles I am facing, and she would want to help me and alleviate my pain,” she said.
Her experiences trying to navigate the Toronto Health care system play a role in her decision to keep her diagnosis private. She hopes that as she learns more about PCOS, she becomes more confident about it.
Ennis has left traditional medical spaces and now relies on her research and trial and error. “My relationship with PCOS became a “me” problem since doctors did not want to offer big help! I find it to be an individual struggle most times.”