South Asian voices

On 15 August 2022, it will be 75 years since India became independent, and Pakistan became a new country. Twenty-five years later, President Idi Amin expelled people of Asian origin from Uganda.

It took another four years for the UK to pass the 1976 Race Relations Act, making discrimination on the grounds of race illegal. In some ways, a huge amount has changed since then; in others, how much progress has been made? 

Frontline spoke to four physiotherapists of South Asian origin – Bilal Azhar, Anu Pal, Mugundhan Thottiam Parthasarathy and Srihari Tippa – about their views and experiences.

I’d like to start with a brief introduction to each of you, and what brought you into this field.

BA: I am from a Pakistani background, so my dad was born in Pakistan and my mum was born here but she’s of Pakistani origin. So I would classify myself as a proud British Pakistani, and I’m also a Muslim, which is very important to me, and also very close to me in terms of my clinical role. I’m currently one of the senior respiratory physiotherapists at King’s College Hospital specialising in critical care.

AP: I am an Indian, proud about my roots and I trained in South India. I came to the UK in 2006 and started working in the NHS from 2007 as a band

6 physiotherapist. In 2019, I moved out of my comfort zone to become a transformation lead managing various projects in primary care. Currently, I am a band 7 clinical coordinator based in Teddington Memorial Hospital in Richmond. 

MTP: I trained in Chennai, and I’ve been working in the NHS for the past 17 years. I spent nine years working in North Wales and then moved to Southeast England back in 2016. I’m now a senior integrated care system (ICS) transformation manager and ICS virtual ward lead for Hampshire and Isle of Wight ICS.

ST: I also trained in Chennai, and I worked there for a couple of years before moving to the UK in 2004. I’ve worked in the NHS since 2006, and I’ve been a clinical lead physiotherapist since 2009. However, as there were no clinical or leadership career progress opportunities within the trust I’ve been pursuing a Masters in Advanced Clinical Practice, which is due to finish soon. 

So how did you get involved in furthering equality and equity within the profession, and what have you been doing? 

AP: I got involved with CSP after work issues which affected my personal life quite seriously. My coping mechanism was to ‘forget and move on’. In 2018, I completed CSP’s leadership development programme, which totally changed my life. I evolved and started to think about myself as a leader, and realised that you don’t need a powerful post to make changes. I started to get involved in system-wide projects;

I was elected as a health ambassador for the trust; and I got the courage to use my trauma in the past to help other physios by working as a CSP steward for two years.

I am very passionate about supporting other people, especially BAME people who might be going through something similar I experienced. Being a part of the BAME network in my trust and as a member of CSP’s Governance team, I have been able to contribute to the equality, diversity and inclusion (EDI) strategies in both organisations. This will be an ongoing work for me.

MTP: It’s a good question. I am passionate about equality and the need to narrow the gap in career progression, development and the experience of BAME staff compared to the rest of the workforce. I found that during my nine years in Wales I was always comparing myself to my colleagues to find out what they’d done and how they had developed and why I wasn’t in a position to do the same. When I moved, I talked to my new manager about my own ambitions and where I wanted to get to – as well as the support I’d need, and to make progress myself. But I could see how other Black and Asian colleagues were struggling, because they didn’t have that access; and I wanted to support them in their own development, so I was focusing on what we could do in that way. 

I was deputy chair of the regional EDI committee in the East of England Region (NHS England) and designed and implemented a survey of the regional workforce views on EDI issues in the workplace and across the NHS. This work was a bedrock for building an evidence based, data informed EDI, flagging up some key areas of concern.  

BA: I suppose my journey started very simply as a band 5 physiotherapist who went to a very big and well known hospital university trust for an

interview. We started off as a group of around 20, but as the stages moved on and people were excluded, I ended up being the only person of an Asian background. And I remember thinking to myself, ‘what is going on here?’ I did get that job, but I felt very isolated – and from that point I started to ask myself questions about how we’ve all got the same qualifications but something more is clearly going on. I worked with a colleague who’s very well-known in the EDI field to research this more and set up support for BAME colleagues where we could discuss these issues more openly. 

And in my current role I’m working with the EDI group setting objectives across the whole of the trust; I’m lucky enough to be the chair; so that’s been a big step up in terms of my responsibilities and roles, though I still I feel like I’m learning as I go. 

ST: Yes, picking up on that last point: I’ve been in my current role as a band 7 physiotherapist for over 13 years now. I’ve been raising the issue of the lack of career progression for all physios beyond that, for around eight years now, and finally realised the only way I can progress is by doing the ACP course. To complete a project for the course dissertation, I opted to take a secondment with Health Education England last year, and took a lead on EDI for allied health professionals within the ICS. We’ve found that although the BAME representation is 22.9 per cent compared to a national average of 22.4 per cent, the majority of this are in lower bands and in un-registered roles – and the percentage reduces further as people move up to higher bands.

Can we talk about working with colleagues and patients? In particular, what about the role of microaggressions – actions or comments which aren’t overtly racist or discriminatory, but which in reality are hugely damaging?

AP: Some can be the result of unconscious bias or it can be due to outright racism. A lot of migrant therapists will have heard the phrase ’go back to your country’ from the patients. I have heard it too. The difference is that in the initial years I worked here, no one did anything about it. Now we have a stricter zero tolerance policy in the NHS and we let the patient know this won’t be tolerated. Being told ‘your food is smelly’ is micro-aggression; and it’s important to make it clear that this isn’t OK.

ST: I have one particular example: about five years ago I was working in an open-plan office and heard one of my colleagues, a rehab assistant,

booking in a patient for me. The patient said: ‘I don’t want any Cadbury chocolate coming into my house.’ And my colleague responded ‘OK, in that case I’ll try to find somebody else to come and see you at home,’ and put the phone down to look for a white physiotherapist.

From her point of view, she didn’t want a conflict. But from mine, as I pointed out to her, she was promoting racism; we should tell the patient that ‘you can’t make a preference based on skin colour’. It really got to me, and I raised it with the team, because for all I knew similar conversations were happening everywhere. We did put policies in place. But how do I know what else is happening? 

I’ve been trained up as a cultural ambassador for our trust, and the issue of micro-aggressions came up a lot in that training; and that made me realise how much I and other Black and Asian colleagues have been exposed to.

Obviously we don’t usually know how to respond, we don’t want to make an issue of it, so we just keep quiet and it builds up – day by day, week by week, till it comes to a point when we just can’t take it anymore. 

MTP: I still remember something similar which happened to me, 17 or so years ago: I overheard a patient saying they didn’t want the ‘P-word‘ and

being told ‘oh, that’s fine, we can arrange another appointment’. I felt quite bad, but at the time I didn’t know how to react. Today I’d approach it in a completely different way.

There are also a lot of micro-aggressions to do with communication, in terms of who is and isn’t included in formal emails, especially ones where we are discussing policies and strategies. In fact, when we’re designing services that extend to service users from a BAME background too, because it’s very important that their voices are heard and included in the design – and that we factor in any objections that they have as well. And interview panels are particularly an issue. In the nine years when I was working in Wales, I was never called in even once to sit on a panel, even though I’d expressed my interest and taking part – and I still see the same thing happening to friends who’re now working in north Wales. 

We need a clear awareness of what micro-aggressions are, in order to address this rather than leaving it too long and accepting things which are not acceptable. 

BA: Everyone’s made a lot of important points already – I’d also add that there are micro-aggressions focused on me as a Muslim.

I’ve always been very clear that I don’t drink alcohol and I’ve had to insist on that. I think I’ve now made it very clear that I’m very proud of my beliefs, and I won’t compromise them for the sake of being social with my colleagues. I know that might be seen as a small example but I know it’s a very common experience for many of my Muslim colleagues in other hospitals. In fact I think religion in general is becoming quite an isolating, marginalising factor today.

Being Pakistani, being a Muslim, can mark you out as a target – you know, you walk into a room of physiotherapists and not a single other person is from a Muslim background or an Asian background. And the others have made some really good points about how we’re stuck around bands 5 and 6 – we talk about the ‘white mountain peaks’, and how the higher up you go the whiter it gets.

One of the things my EDI colleagues and I do at King’s is a lot of awareness and education regarding micro-aggressions specifically. And it’s amazing the amount of feedback I get afterwards, with people saying ‘oh, I didn’t realise this was a thing, or what I was doing’. I think that’s really highlighted for me the lack of awareness on the topic of micro-aggression at every level, from most senior to most junior. People say things ‘in jest’, and I think that needs to be addressed. And that links into the issue of the white peaks, because if people at the top are all white, is change really going to happen because they’re not experiencing it?

ST: Yes, I’ve had the experience that I took a very clear example of discrimination against me from the trust executive board – and the culprits were some of the directors themselves. They acknowledged that it shouldn’t have happened, but they said they wanted to resolve it informally, and they offered mentoring. To me. I don’t know what was offered to the other people. It wasn’t my issue, it was their issue. 

Conversely, has there been specific support you’ve appreciated?

AP:  I’ve had various lovely white managers who were supportive, and a white mentor who totally believed in me. I’ve also been involved in the reverse mentoring scheme, mentoring a white executive director in our trust. He was very open and we could have the kind of conversations you don’t usually have with a white friend; in fact I learned a lot from him. 

He grew up in a totally white community, meeting only one Black child at school. He’d come from a place of real ignorance – he asked me, for instance, ‘is it OK to say Black?’. That is support in its own way, because it’s a two-way learning.

MTP: The amount of career development and other support I have received from NHS England is unbelievable. It really has been life-changing and I’m thankful to the trust and ICS that provided it. 

Extending that last point, can we talk about allyship in general? What can – indeed, what should –individuals and organisations be doing (and not doing) to make this a genuinely inclusive profession?

BA: I think one important point here is that allyship – supporting your BAME colleagues – can very easily become ‘cultural taxation’. I’ve had some brilliant allies, but the key is that they’ve all been from a Black, Asian or other minority background.

When you look at who’s actually leading on the front lines, or disseminating the projects, it’s very rarely people from a white background. So it becomes something more that Black and Asian colleagues are expected to do on top of their other work. 

For instance, I ended up being the person who distributed the calendar and awareness email for Ramadan, when Muslim colleagues who’re fasting will often appreciate some support – but really, anyone can do that. They don’t have to be a Muslim: I’m aware of Christmas, or Diwali, and that’s how we should be thinking about Ramadan. That does involve a negotiation between us and a difference of approach such as, ‘why don’t we do this together’, rather than ‘you do it’. That way you’re going to have a more collaborative approach and one where you learn from me, and vice versa. 

What’s the top recommendation you’d make to a new member of South Asian origin?

ST: Don’t suffer in silence. That’s particularly for people who’ve been recruited from overseas, because they won’t be confident to begin with. When I came here there were terms like ‘bungalow’ that didn’t mean the same to me as they did to my colleagues – for me, a bungalow was a 50-bedroom house. Ask your colleagues what they mean and reach out to people who can help you.   

BA: This is a question that hits me hard when I think back to my younger self. I’d say first and foremost: be confident and brave, be proud of your ethnicity, your background and culture and religion – don’t shy away from them. You know that’s who you are, so claim it. 

And yes, speak out. Silences can be quite deadly, because they allow practices to carry on, so having that confidence in yourself is key. Reach out to the people who are fighting for the same things as you are and try and form a bond with them.

Try to be involved as much as you can, and make your voice heard.  

MTP: I agree completely. Ask your host organisation what forum they’ve got in place to support newcomers. It’s the organisation’s responsibility. This is a big move and the NHS needs staff – it’s their responsibility to put the right support in place for them.

There is an unspoken and implicit expectation from colleagues that members who were raised and trained abroad will work in exactly the same way as someone born, raised and trained in the UK, and that the ‘benchmark’ is set by professionals from the UK.

I’d also advise new members coming from South Asia to get involved with the CSP, to identify a senior sponsor in their organisation and to draw upon allyship opportunities that the CSP and staff networks facilitate so that they are able to ‘translate’ the culture of the NHS and successfully navigate their way through it.  

AP: Yes, you need to be involved in a staff network, and in the CSP as these are good support systems. It’s important to know your rights, and to know how the system works in order to work better in it. I’d also say that it’s good to get involved in the local community more widely. Networking is key (and remember this can also be in social media groups). But also: you don’t need authority for leading. Don’t hesitate to ask questions and don’t listen to people who say you’re not ready. Grab opportunities and apply for posts. You need to take a chance.