Proposal: What is the Saudi/American medical status quo?

The Ways in Which Disenfranchised Groups are Discriminated Against Within Healthcare in the United States and Saudi Arabia

Driving Questions:

What are the ways in which people are discriminated against within healthcare in Saudi Arabia and the United States?

What is the current medical status quo, both in Saudi Arabia and the United States, especially in regard to disenfranchised groups in these regions? 

How can we resolve the disparate ways in which people are treated medically? 

Content Advisors: Dr. India Bailey, Mr. Lanis Wilson

In America, there is a huge disparity in the way people are medically treated. Medical discrimination is rampant, especially in a world so drastically affected by a pandemic. In order to get to the bottom of this issue, a study into the institution of America is necessary. Additionally, 27.5 million Americans still lack access to healthcare, the highest rates of which being amongst Black, Hispanic, Indigenous peoples and Alaska Natives. There is a clear racial disparity within access to healthcare. This is just statistics of people who don’t have healthcare— there is a clear disproportion in the way that white patients are treated in comparison to patients of color. While medical schools are doing what they can in order to combat racism in their treatment of patients, it clearly isn’t enough as there are still cases of discrimination being reported. Is this issue of racism in medicine solvable, or is it due to the deep roots of segregation and discrimination entangled since the conception of America itself? 

The problem of healthcare in Saudi Arabia is both strikingly similar to that of the United States, yet still very, very different. Due to the kafala system, there is a set social hierarchy in Saudi Arabia. This system sets a dangerous precedent; one in which certain people are lower than others due simply to their nationality. This precedence carries over into healthcare, as migrant workers are not allowed the same liberties and freedoms that Saudis are allowed. Migrant workers in Saudi Arabia often don’t have the same free healthcare that Saudis are privileged with. Their sponsor, while forced by law to provide them with healthcare, often just buys the cheapest and most non-comprehensive healthcare, and then doesn’t take their workers to appointments. This racism against migrant workers, in favor of Saudis, is a primary foundation into why they are not allowed the same healthcare privileges. How do we solve this issue? Do we need to dismantle the entire modern day kafalah system? 

Preliminary List of Resources: In order to further study this issue, I will read the firsthand accounts of patients treated disparately. Due to the opportune area we live in, I also plan on having interviews with medical school directors in order to hear a firsthand account of the ways in which medical schools are currently combatting racism in medicine, and if this is enough. In order to see how the kafalah system has affected healthcare for migrant workers in Saudi Arabia, I will speak to hospital administration at a Hospital in the capital of Saudi Arabia in order to further understand exactly how the healthcare for migrant workers is implemented. 

Reading Material:

The Faces of Poverty in North Carolina by Gene R. Nichol 

Undocumented migrants in Saudi Arabia: COVID-19 and Amnesty Reforms

Civic Stratification and the Exclusion of Undocumented Immigrants from Cross-Border Health Care

Social Determinants of Health and Health Disparities Among Immigrants and their children

Racial and Ethnic Disparities in Health and Healthcare

Design & Evaluation of an Interdisciplinary Health Disparities Research Curriculum

Development of a Multifaceted Health Disparities Curriculum for Medical Residents

Health Equity in Action at the Duke PDC

Professors to Reach Out To (Tentative List. More to be Added):
→ Gene R. Nichol

→ Fahad Al-Sharif 

→ Kimberly S. Johnson

→ Julius Wilder

There is also a hope that I will reach out to patients who have experienced racism in their treatment, with my mother acting as a liaison. This is tentative, however, I do have informed consent forms from the NIH and I’m working on applying for an IRB. 

Month by Month Plan:

JanuaryApply for an IRB
Fill out informed consent forms and send to the NIH
Finish preliminary background research
Finish reading The Faces of Poverty in North Carolina
FebruaryEmail prospective interviewees
Finish reading about prospective solutions that are currently
being implemented
Research possible solutions that can be implemented,
but haven’t been (yet)
MarchInterview Month:
Interview medical directors, patients who have
felt discrimination within healthcare because of their
race/ethnicity, as well as professors who study and have
tried to develop solutions for this issue
AprilWrite first draft of academic paper
MayFinish academic paper
Send academic paper out for peer review