Medical Student Creates Handbook of Clinical Signs on Black and Brown Skin

Siobhan Harris


July 14, 2020

A Black medical student has created a handbook to help trainee doctors recognise conditions on darker skin.

Malone Mukwende, a second year student at St George's, University of London, had the idea after only being taught about clinical signs and symptoms on White skin.

The handbook is called Mind the Gap. It contains side-by-side images demonstrating how illnesses and diseases can present in light and dark skin.

He hopes the handbook will help future doctors spot and diagnose potentially life-threatening diseases on British Asian and Minority Ethnic (BAME) people. 

It comes as nearly 200,000 people have signed a petition calling for medical schools to include BAME representation in clinical teaching.

It points to Kawasaki disease, a rare condition affecting young children. On white skin it appears as a red rash but on darker skin it shows up differently and is much harder to spot.

Medscape UK asked Malone Mukwende about the handbook.


Where did the idea come from for Mind the Gap?

On arrival at medical school I noticed the lack of teaching on darker skins. We were often being taught to look for symptoms such as red rashes. I was aware that this would not appear as described in my own skin. When flagging to tutors it was clear that they didn’t know of any other way to describe these conditions and I knew that I had to make a change to that. After extensively asking peer tutors and also lecturers it was clear there was a major gap in the current medical education and a lot of the time I was being told to go and look for it myself.

Following on from that I undertook a staff-student partnership at my university with two members of staff who helped me to create Mind the Gap. 

Who did you collaborate with at St George's?

I worked with Margot Turner, a senior lecturer in diversity, and Dr Peter Tamony, a clinical lecturer. We were a dynamic team which had a common goal in mind.

When will the handbook be available?

We are currently working on the best way of disseminating the work to the public. There has been an incredible response since I posted it on my social media, with posts being seen over three million times as well as numerous press features. I am hoping to provide a further update on when the book will be out towards the end of July. 

What do you think of the petition to medical schools to include more teaching of the effects of illness and diseases on Black, Asian, and Minority Ethic people?

The petition closely ties in with the work that I am doing. It is clear that there is an urgent need to increase the medical education on darker skins so that the profession can serve the patient population. We saw in the recent COVID-19 pandemic that the worst affected group of people were from a BAME background.

There are a host of reasons as to why this may have been the case. However another factor may be that healthcare professionals weren't able to identify these signs and symptoms in time. Some of the coronavirus guidance from royal colleges stated information such as looking for patients to be 'blue around the lips'. This may have led to slower identification of coronavirus.

To see over 180,000 signatures on the petition was a positive step in the right direction. It is clear to see that this is a big issue. If we fail to act now that the issue has been identified, we run the risk of lives being lost. 


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