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Representation: Are we achieving this in Paramedicine?

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Mahdiyah Bandali

When I was a little girl, I dreamt about becoming many things: a vet, an actress, an engineer … the list went on and on. And whilst it seemed that I may have considered almost every vocation as I was growing up, Paramedic was never one of them. Through the many ups and downs of life I somehow fell into this role after leaving school and can proudly say I have never looked back since. Yet, I do wonder why my younger self didn’t think of this profession as the perfect fit. Growing up in the second largest city in the UK, I was constantly exposed to ambulances going up and down the main roads but never imagined myself in that situation. 

Last year, Gamillo (1) writes, Barbie™ created a new set of dolls which included key women who contributed to the COVID-19 pandemic in the hope to “inspire children to take after these heroes and give back” and “nurture and ignite the imaginations of children playing out their own storyline as heroes”.  Representation is key. And when I think back to how I came into Paramedicine, I realise that the choices that were displayed in front of me didn’t seem like choices I was able to make. I did not see other Paramedics that looked like me, and therefore thought it wasn’t a potential career for me. And whilst I have been lucky with the way things turned out, it leaves the question of the many others in my position who may not have been. 

195 countries in the world holding people speaking one or more of 7100 languages; a statistic like this does not do justice to the level of diversity there is within the world. Race, gender, sexual orientation, disability. We are surrounded by diversity constantly. Not only this, but the level at which we are exposed to these new cultures and people from different backgrounds is changing at an exponential rate.  I clearly remember when the very first East African restaurant opened in my city, and how excited my family was to go somewhere that would remind them of home. We would tell all our friends about it, revelling in the joy of being able to share something so meaningful in our culture with others. And then we met more people from the countries my parents came from, found comfort in exchanging memories and conversation, reminiscing on key events, and having a true sense of belonging. Whilst there are different attitudes to change, some more negative than others; diversity in its essence is the same as what my family experienced walking into that restaurant. It is making others feel part of something, feel included and have the opportunity to be able to share in the same joy that others experience, but offer a new way of looking at it. 

With the world developing the way that it is, and the environment around us constantly bringing new ideas and innovations, the question arises that why some areas are not at the same level of change than others. Paramedicine, like other healthcare professions, has the aim to treat all conditions, regardless of who the person is and where they have come from, and it is only natural that a profession which strives for equality would demonstrate this in the workforce as well. However, I, like many others, witnessed first hand that this was not the case. Whilst my personal experiences are solely based in the UK, there does seem to be a trend of the profession being more attractive to one type of individual. With Paramedicine coming from an army centric background, there is no doubt that there was a dominating representation of white males in the workforce. Although, the role of a Paramedic has changed drastically from what it was, and so has the environment in which Paramedics practice. Yet why is it that diversity and growth has not reflected in those changes?

Some might argue that this is not an issue, in a situation in which Paramedics are trained to treat such as a cardiac arrest or a heart attack, would it make such a difference if the patient in question was being treated by a white male, or an individual from an ethnic minority? Medicine is so much more than treatment pathways, procedures, and medications. There has been sufficient research to show the value of holistic healthcare in attaining the best possible outcomes for patient and approaching their treatment from a well-rounded approach. Therefore, whilst the intervention to treat the incident on hand may have been the same regardless of clinician, there may be certain things that an individual from a different culture or background would have noticed that someone else may have not. We are lucky, as Paramedics, that we are given the honour of being able to assess a patient often in their own homes, where they can feel at their safest and comfortable to disclose their needs. A home is not just an environment in which we have a patient, but rather a depiction of this individual and their culture and as Paramedics who strive towards delivering holistic healthcare, we should do justice by the patient to understand, or at least try to understand our patients. One of the pivotal moments in my career in which I realised the necessity of a workforce that is representative to our patients, is when I attended the cardiac arrest of an individual of the same faith as me. The family was distraught, they had recently moved to the UK and did not know how to react to us working on their family member. They began to intervene in the treatment and pull us away. I was working with a colleague at the time who did not understand their point of view and was getting frustrated because of the differences in their culture about approaching death compared to his. However, coming from the same faith I was able to empathise with their situation. I sat down with them, recited a few prayers and chapters from the Qur’an (Book of faith in Islam) and explained our treatment in a way that was easier to understand for them. Instantly, their moods had changed, and they let us carry on with the work we needed to do. 

Representation is not just putting a face of someone who does not look like the usual type of a Paramedic on a poster and believing that it is sufficient to indicate the workforce is diverse. It is acknowledging the various aspects that make a person unique and trying to learn those differences whilst embracing them. Here are some ways that we can start working towards to help us strive towards representation in Paramedicine:

● Representation is not a checklist activity – whilst using individuals from diverse backgrounds in promotional material is a great and fantastic way to initiate the process, it is important to note that it is not the only method and is more effective when done with material alongside it that demonstrates how you, as a workforce and organisation, support that individual. 

● Representation needs to be done in all areas of the organisation. Often, we can start increasing the diversity of the workforce from the frontline however it is not reflected in the leadership positions. How can we expect to retain staff who feel they do not have a voice because they are not represented in those that are the organisations “decision makers”?

● People need to feel included and will listen and be more likely to act on what they have heard from someone who they can relate to. Therefore, if you have a white member of staff, talking about how we need to increase diversity – it won’t be as effective. 

Representation is not the work of just one individual but a whole organisation’s responsibility. Recognising it is perhaps the most difficult issue, but necessary in all aspects of what Paramedicine strives for from our staff to our patients. 

Global Medic 20210400

References:

1. Gamillo, E., 2021. New Barbie Dolls Honor Covid-19 Frontline Medical Workers From Around the World. [online] Smithsonian Magazine. Available at: <https://www.smithsonianmag.com/smart-news/mattel-honors-global-frontline-medical-workers-barbie-dolls-180978454/> [Accessed 31 March 2022].


Want more from Mahdiyah? Check out her recent TEDx Talk

Destructing Cultural Constructs: Being A Hijab-Wearing Paramedic-Mahdiyah Bandali- TEDxMoseley

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Mahdiyah Bandali

Mahdiyah Bandali

 Mahdiyah Bandali works as a Paramedic in multiple areas of the NHS from Primary Care to Frontline Services and is a Visiting Lecturer in Student Paramedic university education. Alongside this, Mahdiyah is a columnist for the Journal of Paramedic Practice and an active member of the College of Paramedics and the British Islamic Medical Association.   

During her time in the Ambulance Service, Mahdiyah became very passionate about advocating for Equality, Diversity and Inclusion after experiencing discrimination and islamophobia. Hence, she regularly uses her voice through social media in raising awareness of discrimination and has since been recognised by the Huffington Post and Metro news publishers. As a Muslim, Mahdiyah also enthusiastically promotes awareness of religion and culture and has worked closely with several mosques and community centres within England to teach basic life support and first aid skills.

Social media: @HijabiParamedic on Twitter and Instagram

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