‘Your name is difficult to say, can we call you….’

‘Your hair is very unprofessional – we have policies about hair being kept tidy’

‘Ha ha. Your name is so funny!’

‘Can I touch your hair? It’s so springy and big!’

Microaggressions are defined as ‘verbal, behavioural, and environmental indignities that communicate hostile, derogatory, or negative…slights and insults to the target person or group’ (1).

In the UK historically there have been varying degrees of tolerance towards migrant populations, with varied definitions of tolerance as outlined in research (2) about changing levels of tolerance in the UK. But for many, ‘tolerance’ does not mean ‘acceptance’.

DADA: Founded Melanin Medics

Ignorance has led to workplace policies that specify natural afro-textured hair as ‘unprofessional’. There is a deep lack of awareness that the perceived ‘professional’ hairstyle can only be achieved for many black women by undergoing unregulated chemical treatments.

This general lack of understanding about natural afro textured hair is prevalent across all nations, Emma Dabiri’s book, Don’t Touch My Hair, documents the history of afro-textured hair and how we got to this current position of misunderstanding and discriminatory hair policies.

This problem of discrimination on the basis of natural afro-textured hair has been recognised internationally as such a significant problem that we now have World Afro Day, endorsed by the UN Office of the High Commissioner for Human Rights on the 15 September. There is also legislation to protect the right for black people to keep their hair in its natural form in the USA.

For doctors and other healthcare workers this issue has been highlighted by Olamide Dada, founder of the organisation Melanin Medics. Her blog captures the frustrations of not being able to participate equally in a workplace setting because of not having access to a surgical cap that would fit over her hair.

Accurate pronunciation of a person’s name is a sign of respect. In different cultures names have different meanings and different practices.

This UK produced guide from 2006 is outdated now and doesn’t cover several interesting naming practices, such as Akan Ghanaians being named after the day of the week they were born or the Scandinavian practice of patronymic surnames, but it does show the breath of diversity of naming practices.

Globally, many companies will put resources towards training their staff who are based internationally to learn how to say names and be respectful of the countries and cultures they are interacting with – it makes business sense.

Families from white minorities with names that were notably not English have in the past changed their names to integrate better into UK society without discrimination, eg: Irish, Eastern European, German and Jews.

People who are visibly different from the white majority, eg, from Indian and African backgrounds may have adapted their names or added an English first name. In some African countries this has been the norm since colonial times, to the extent that there may be several generations of people with atypically ‘English’ names.

Saying someone's name incorrectly is not illegal. But the impact, intentional or not, can be upsetting. Context is important to consider. Imagine, on the one hand, someone saying a person’s name for the first time and making a mistake. Or on the other hand, someone mispronouncing a colleague’s name, a person they see on a day-to-day basis, over a longer period. The second scenario is more likely to be considered a microaggression.

If you are struggling with a name, ask how to pronounce it then try to pronounce the name. It is as easy as saying 'I’m sorry, I’m not quite sure how to pronounce/and or spell your name, could you tell me please?' Inevitably, some people are better linguistically and will pick it up quicker than others. But, taking the time to learn, showing interest, and attempting to get someone’s name right, is a way of demonstrating your respect for them. 

As with many of these issues related to microaggressions and identity there is often a mismatch between intent (from the perpetrator) and impact (on the victim).

When does a comment about hair or mispronunciation of a name become bullying and harassment? How long is a piece of string?

It might depend on the number of times it happens, if the person has been corrected, and the overall nature of the interactions.

What about a situation where a person tries to touch someone’s hair because they find it interesting and different? This unwanted physical conduct is a form of assault legally. Would it really be ok to touch anyone’s hair you aren’t in a close relationship with?

We all want workplaces where doctors are free to train and work without barriers based on race, religion, or any other protected characteristic. Names and hair are intrinsically linked to race, therefore these types of friction will occur.

Often at a level that is difficult to explain because 1) it’s intangible, 2) if you have never experienced it you would not be able to identify it as a problem and 3) it might be the culmination of several minor incidents or negative behaviours.

It might be easier to think of the need for correct pronunciation, and inclusive dress practices, in terms of human rights principles:

• Freedom. The freedom to be who you are, freedom to express yourself, and learn about other cultures respectfully
• Respect. Having respect for someone’s history, family and culture – as you would expect the same for yourself
• Equality. Viewing other people’s names and natural hair as equally valid to those which you are used to
• Dignity. Affording others dignity by having policies that do not discriminate against who they naturally are.

The way to improve the environment you work in to be inclusive and remove those microaggressions needs three things:

1) Systems that do cater to difference. E.g. surgical caps that accommodate all types of hair and religious dress practices, and policies that don’t include a requirement for ‘skin-coloured’ tights in recognition that it’s difficult to find ‘skin-coloured’ tights for all skin colours. Most importantly, personal protective equipment that fits all body shapes, genders, ethnicities, religious dress practices, to ensure all medical staff are protected equally.

2) Space. We need more space for people to be angry and frustrated when someone doesn’t get their name right or makes an insensitive comment about their hair or dress practices. It’s natural for people to upset if they don’t feel respected or acknowledged and people should have the freedom to express how they feel and to be listened to. Conversely, there must be space for people to, in good faith, learn and make mistakes. If the intention is to learn not harm, then give people the time to learn and improve.

Our Bullying and Harassment report refers to this as ‘cultural humility’ and a key component of forming positive relationships. It involves ongoing self-reflection and learning, actively engaging with others, and considering things from the perspective of others.

3) Open dialogue about different types of hair, names, and dress practices and why it is important. The theme of Black History Month 2021 is Proud To Be. It's time to celebrate, respect and value racial diversity in the workplace.

Some BMA members told us why they are ‘proud to be’ and what their hair and names mean to them…

Corah Ohadike 

My surname, Ohadike, is my father’s surname and I use it professionally as it is a representation of the hard work that my father put towards getting me my university education. It reminds me of all the sacrifices and determination it took for him to make from a life of poverty and being an orphan to becoming a renowned scholar and successful diplomat in the UN. It also means ‘Unity is Strength’ and this is an important mantra which I apply to many facets of my life and profession.

Phoebe Owen

My hair – like many of us – has been on a journey. My early teenage years brought the use of a relaxer, trying always to temper and tame my afro to something more ‘acceptable’; mirroring my desperation to blend into my white suburban surroundings at that age. But now my hair is a celebration of its natural state (albeit in box braids for ease of maintenance at times!). Just as I, now 34 years old and proud in the skin I'm in, am no longer bound by the need to be tempered, to be tamed into something more ‘acceptable’. My hair celebrates the journey I have been on. I am who I am. I was not put on this earth to blend in. My hair takes toil, struggle, pain... much like the history of my ancestors, and my present state. But there is great beauty in that toil; beauty in the struggle and in the pain. It's well worth celebrating.

Ekene Clair Agbim

My mum gave me seven names: Ekene Clair Ifeoma Monique Justine Godfreda Adaora. In her infinite wisdom, and to ensure practical inclusion of a young black British girl of Nigerian origins in 1970s England, she thought: what better way to feel a bit more included, than by your name. My mum would say: I named you with names not only pregnant with meaning, but that would also enable you to live in different parts of the world with more ease. This later point is a consideration that many from ethnic minority backgrounds ponder.

I (by virtue of my hair) have been braided to my back mid-way, weaved (that didn’t last), permed (neither did that), dreaded (to my coccyx), and now I sport a short afro, that I opt to often wear colourful wraps around, or not. 

All I wore & wear, as mine, and none was ever petted, but instead wondered upon, curiously enquired about with smiling mouths and eyes. Whilst I don’t define myself solely by it (my hair), it has always been a source of comfort, and pride, much like the shape of my nose,  or the curve of my eyes. The likeness I see in my afro hair when I had it long, with my mother’s when she had hers the same. I see therefore my journey with my hair, during different times of my life, my family, my heritage, but most importantly my personal unique expression of what happens to grace my head.

Shobhna Shah

My parents named me so based upon letters in Gujarati alphabet assigned to my birth sign (Kumbh Rashi) in the lunar calendar. It is auspicious to name the child with the first letter of the three assigned to the Rashi. My name is a key to my identity and culture. Pronouncing it correctly is to respect that. My name is my pride, my essence of being and my soul.

Anil Jain

I was born in a small town in North India, rather a long time back. Anil is one of the commonest names in India and most likely that is why my parents gave it to me. Anil (Sanskrit: अनिल) is an Indian masculine given name originating in the name of the Vedic deity Anila. It means wind in the Sanskrit language. Thankfully, it is very easy to pronounce and has saved me a huge number of difficulties which I would have faced otherwise. I loved to be called Anil as it shows people can come closer to me rather than calling me Dr Jain which sounds more woody! It has become part of my identity now and I am proud of it as are my family, friends and colleagues.

Aishnine Benjamin is head of equality, inclusion and culture at the BMA 

Footnotes

(1) When and how to respond to microaggressions; 2020; Washington, E Birch, A Morgan Roberts, L; Harvard Business Review

(2) Are today’s youth more tolerant? Trends in tolerance among young people in Britain; 2019; Janmaat, J and Keating, A; UCL Sage journals