By Nebal Snan, Local Journalism Initiative Reporter, The Chronicle Herald
February 24, 2022
Khadija Abawajy remembers the moment she saw a Black medical student who wears the hijab for the first time on campus.
“I was so excited. … It filled me with so much joy,” said Abawajy, who also identifies as Black and Muslim.
Abawajy did not encounter many Black or Muslim physicians, medical students, or pre-med students as she completed her undergraduate degree in medical sciences at Dalhousie University. Her class only had one other Black student whom she quickly befriended.
She said the lack of representation left her sometimes feeling like she didn’t belong.
“If you don’t see yourself represented, you can question, ‘are you able to do this?’”
Abawajy proved she could when she was accepted to Dalhousie University’s medical school, joining about a dozen Black students in her cohort. But her journey wasn’t always smooth sailing.
Systemic racism in medical schools
A study conducted in 2018 found that medical students in 11 Canadian medical schools were less likely to identify as Black or Indigenous compared to the 2016 census. For example, only 1.7 per cent of respondents identified as Black as opposed to 6.4 per cent of the population.
The exclusion of Black students from Canadian medical schools goes back centuries. Queen’s University banned Black students from enrolling in its medical school for about 50 years, starting in 1918.
The change came on the heels of the 1910 Flexner Report, which aimed to standardize medical education in the U.S. and Canada. The author of the report, Abraham Flexner, suggested that Black physicians can only treat Black people and that they must be trained in “hygiene rather than surgery, for example.”
Queen’s University did not officially repeal the ban until 2018.
According to a 2020 report by University Affairs, McGill University, Dalhousie University, and the University of Toronto also placed restrictions on the admission of Black students into their medical programs for varying periods of time.
Entrance exams cost thousands
A number of barriers — many of which are tied to systemic racism — continue to make medical school inaccessible, said Abawajy.
The standardized medical college entrance exam (MCAT) and the costs associated with it, she said, is one of the factors perpetuating an inequitable admission process.
Canadian data on socioeconomic status by race are sparse, but non-profit organization Canada Without Poverty says one in five racialized families live in poverty in Canada as opposed to one in 20 white families.
“We need at the end of the day, more BIPOC doctors. There’s studies that show that BIPOC health outcomes are worsened when they don’t have culturally competent care. That’s why it’s really important to be able to have BIPOC students get into medical school and be supported throughout the process.” – Khadija Abawajy.
A requirement to get into most medical schools in Canada, the MCAT costs hundreds of dollars. Most students also take a prep course to achieve the target score sought by medical schools, costing an additional $3,000.
As people around her debated which prep course to take, Abawajy knew she could not afford any of them.
“I can remember thinking, … I’m not able to take a prep course, I’m not going to do as well as the students who do. So even just that self-stigmatization is there.”
Relying on the prep books she was able to get, Abawajy studied day and night. But it wasn’t enough to get the score she wanted on her first try.
It wasn’t until she met a friend who had taken the MCAT before that she was able to reflect on her performance and improve her strategy at tackling the test.
Making these precious connections can also be a challenge for students from marginalized communities.
Many university student associations plan networking events centred around alcohol, such as wine and cheese networking events, brewery tours, and beer nights at the pub. But there are Muslim students like Abawajy who don’t feel comfortable attending such events and miss out on the opportunity to connect with peers and mentors.
Finding role models in family
Abawajy, like many students from marginalized communities, is the first medical student in her immediate family. Her parents immigrated from Oromia in the 1990s and have since lived in Halifax, operating their own business.
Compared to peers who had a family background in medicine, she didn’t have immediate access to valuable experiences such as shadowing doctors or working in patient care before getting into medical school. She was mostly on her own at the beginning, without anyone to give her advice on what undergraduate program to choose or what kind of extracurricular activities to do if she wanted to apply to medical school.
But she followed her family’s lead — her parents were involved in the Oromo and Muslim communities and her older sisters had student leadership positions at Dalhousie University. Inspired by the role models in her family, Abawajy revived Dalhousie’s Muslim Student Association and became president of the society during her undergraduate years. She said she grew through the experience and was later able to use it when she applied to medical school.
How medical schools are changing
Universities across the country have recently implemented changes to their admission process to help even the playing field for Black students.
@khadija_abawajy.md Some general tips, including how long to spend prepping for an interview #premed #premedlife#premedtips #premedadvice #mcat ♬ original sound – Khadija Abawajy
The University of Toronto, for example, was the first Canadian university to create an optional application stream designed for Black students to ensure their identity is taken into consideration when their application is reviewed.
Self-identifying Black applicants have members of the Black community, Black physicians, and students taking part in their admission process, providing them with a safe space as they feel that their experiences will be understood and valued. Applicants must meet the same academic requirements – the MCAT, grade point average (GPA) and course prerequisites – as all other applicants.
Other universities have followed suit or implemented their own strategy to increase diversity in their medical programs.
Dalhousie University’s medical school doesn’t currently have a stream specific for Black students, but Indigenous and Black students are encouraged to self-identify when applying. According to their website, the school is working on developing“priority communities admissions application streams and processes.”
Feeling ‘subpar’
The university has also created a program to support students of African descent planning to study or already enrolled in a health professions program such as medicine and dentistry.
The Promoting Leadership in health for African Nova Scotians(PLANS) program pairs applicants with mentors to help them with the application process.
Knowing how difficult it can be to find a mentor, Abawajy is now offering mentorship to prospective medical students through PLANS.
“We need at the end of the day, more BIPOC doctors,” she said. “There’s studies that show that BIPOC health outcomes are worsened when they don’t have culturally competent care. That’s why it’s really important to be able to have BIPOC students get into medical school and be supported throughout the process.”
Despite the positive impact of such programs and streams, Abawajy said she’s heard comments that students who use them are “subpar” or “don’t deserve” to have their application accepted.
“Those are things that you will face while in medical school, and throughout the application process as well, feeling like you’re not as worthy as the other candidates.”
Living ‘the immigrant story’
It took Abawajy two tries to get accepted into Dalhousie University’s medical school. Wearing a mask with the Oromia flag colours, Abawajy said that being a daughter of immigrants played a large role.
“I think that’s the immigrant story, right? You have your parents that persevered and so it motivates you to also be very resilient and strong in your pursuits,” she said.
She is now sharing the lessons she learned through TikTok. Her videos include resources for pre-med students, advice on taking the MCAT, and tips on putting together a strong application.
For Abawajy, being on the popular social media platform is a chance to help students who find themselves in the same situation she was in a few years ago.
“I think it can really demonstrate that we do have the ability to be in these spaces,” she said.
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“Another reason why it’s really important for me to be doing this is that I pretty much did every step of the application process twice … I don’t want to just have this knowledge that I’ve accumulated over five years and just let it like dissipate.”
You can follow Abawajy on TikTok at khadija_abawajy.md
