In medical school, students learning about illness, pathology, and disease are trained almost exclusively on images of white patients. Even materials on illnesses that predominantly affect Black people, like sickle cell disease, and textbooks used in medical schools in countries where most people are Black, are filled with illustrations of white bodies and white skin. This leaves doctors underprepared to care for Black patients.
For Nigerian medical student and illustrator Chidiebere Ibe, accurate representation is a starting point for health care equity. Ibe has founded Illustrate Change, the world's largest open-source digital library of medical illustrations featuring people of color.
In this episode of The Dose podcast, host Joel Bervell talks to Ibe about his efforts to make inclusive imagery widely accessible — a critical step toward building health systems that can provide Black patients with the care they deserve.
Transcript
JOEL BERVELL: My guest on this episode of The Dose is Chidiebere Ibe. He’s at the forefront of a transformational change in the field of medicine. His work addresses a health care gap that I also noticed during my first days in medical school. In medical school, when we talk about illness, pathology, and disease, it’s often illustrated exclusively on white patients as models, and I couldn’t stop thinking about that. Lyme disease is one example that I’ve talked about on TikTok. Doctors are taught what a Lyme rash looks like on lighter skin in the United States, not on darker skin tones. That disparity leads to delayed treatments for Black patients who have Lyme disease, causing an increased likelihood of late manifestations of the disease, like neurological and heart complications.
That’s just one example of the serious implications of accurate and inclusive illustrations on patient care and outcomes. Studies show that in some textbooks, less than 5 percent of medical images show people with darker skin tones, and only 8 percent of the people making these images identify as people of color.
So it’s a huge privilege for me to have this conversation with someone whose work I admire so deeply. Chidiebere Ibe is not only the creator behind Illustrate Change, building the world’s largest library of diverse medical illustrations to help increase representation in health care. He’s also a third-year medical student at Copperbelt University in Zambia, and his home is in Nigeria. He’s also creative director and chief medical illustrator at the Journal of Global Neurosurgery and medical illustrator at the International Center for Genetic Diseases at Harvard Medical School. But, he’s maybe best known for the global conversation and sensation he unleashed by posting a Black fetus illustration in 2021. I remember that my TikTok video that I made on his work received over 5 million views in 24 hours, sparking conversation and showing the importance of his work.
Thank you so much for joining me for this conversation, Chidiebere.
CHIDIEBERE IBE: Thank you so much, Joel, for the wonderful introduction. I’m honored to be here.
JOEL BERVELL: Absolutely. So let’s begin by talking about your project, Illustrate Change. You’re building a digital library of medical illustrations featuring people of color. Right now there are over a hundred images including maternal health, orthopedics, dermatology, ophthalmology, and so much more. What’s the primary goal, and is this resource downloadable and free to all?
CHIDIEBERE IBE: The idea was to bring more diversity and inclusion in medical literature to see how to give access to these images, because one of the problems we had in terms of these images was access to these illustrations. So we decided to make it free and open source to everyone who could download the images and use them for educational purposes, of course, giving reference to the source. So for now, the images are open source, they are free, they’re downloadable. Additionally, we are still uploading more artworks on the website. So I would say it’s open source, it’s free for anyone and accessible by everyone.
JOEL BERVELL: I love that. And both of us are medical students right now. We’re still learning, but we also know, and I think we both recognize this, that observation is critical. So much of patient care is determined by observations made by doctors, nurses, other medical professionals. Given the historical absence of this type of visual information and illustrations, how do you prioritize which images are most urgent to create an ad? Is it being done by disease category, epidemiological data, or other factors?
CHIDIEBERE IBE: Well, considering data is always, I would say, the important thing I consider when creating an artwork. And a couple of times, I mean, you could also tell, most times when you create a piece, you go through the comments to see people always talking about if we create a piece around this particular topic. Some time ago I asked my followers on Instagram what area I should create artworks for. So I had a lot of requests about certain topics to create more, and for me, I had to make deep research. How does this affect the Black community? I don’t do so much of anatomical illustrations because anatomy really hasn’t really changed so much.
But focusing on areas in medicine, in terms of dermatology or diseases that not really talked about that much. Sickle cell disease, which is very common in Africa, yet there is little visual creations around sickle cell disease affecting Black people. Dermatology, malaria, for example, affecting the Black community and not so much having done regarding that. And I tend to also pay attention to requests. I had emails from several clients who had complaints who were patients, who had said they felt unseen because of the particular condition they had, like lupus, for example. So I focus on areas that affect the Black population and the minority group generally.
JOEL BERVELL: Yeah, I think there are multiple things in what you just said that I resonate much with. The first is that crowdsourcing and listening to the audience. I always say this, and so maybe I’m on my soapbox right now, but I think social media is a beautiful way to build community, especially with communities have been overlooked. And the comments, as you mentioned, are this incredible space to see what are people focusing on or what have they not seen online or can’t find that information in other places so that we can add to that information. And you’ve mentioned three already, malaria, sickle cell, and lupus.
I’m hoping we could actually maybe dive a little bit deeper into each of these diseases and the role that images play for people of color and enhancing outcomes for patients. So, for example, I think about lupus has for a lot of patients what’s called a malar rash that happens on your face, but often times it can be difficult to see in Black patients. I actually still even to this day am unfamiliar with what it looks like because my textbooks haven’t shown me. So if you can talk about each of those diseases a little bit more about the power of starting with images as diagnostic tools.
CHIDIEBERE IBE: Well, let me just start from lupus as I mentioned the condition lupus. So I think a month ago I had a friend of mine who reached out to me and said that she met someone at the airport that was in Nigeria. She met someone at the airport, and she had lupus. So a friend of mine is discussed with her that he knows someone that creates Black illustrations for Black people. And she said that she’s tired of explaining that lupus is not something diabolical because in Africa we consider lupus because you have hair loss, tend to have the malar rashes. In Africa, people misconstrue it as being diabolical or having witchcraft. So because of lack of understanding, because of lack of education, and because of lack of diverse illustration that communicate this condition accurately.
And this was a research carried out in South Africa, which was carried out among Black patients who had lupus and talking about malaria, which is very common in Africa. If you Google malaria right now, all the resources, all the illustrations you would see is malaria on the white skin. This is a disease that affects . . . so many Black people die of malaria every year. Yet the disease process is not being accurately illustrated on black skin. We don’t know how it looks like, how it affects Black people. And I mean, it’s sad to realize that this is a disease that affect Africans, yet the images you see on social media, on the internet, does not show any on Black people. I mean, it’s something to really consider.
And talking about sickle cell, sickle cell has been . . . I mean, it’s really a topic that I’m so passionate about because I have friends around me who are sickle celled and they feel so underrepresented. In certain times when I created an article around sickle cell because from research, sickle cell affects over 300,000 babies every year in West Africa, but there is no accurate researches that show sickle cell and Black people having the foot ulcer, having the leg ulcer, how the blood is looking sickle. And a lot of people have created advocacy around sickle cell. But if we decide to create illustrations that we depict or that represent the sickle cell community, it could be as a greater approach to advocating for them.
JOEL BERVELL: I love what you’re doing. It’s so powerful the way that you’ve just laid out there. One of my favorite series that I’ve created is called Derm on Darker Skin. What I go and do is I show what a dermatology condition looks like on lighter skin and on darker skin. Super simple, but a lot of people resonate with it because it might be the first time they’re seeing themselves represented. But what I’ve also realized is that a lot of people will start asking in the comments, “Is this a problem only here in the United States or worldwide?” And I’m curious, from your experience, can you talk maybe about the education just like going to school in Zambia in medical school. What does a dermatology unit look like? Are you getting this education on darker skin tones? Are you not getting it? What is just your personal experience?
CHIDIEBERE IBE: I think that’s really a fantastic question. My first year in medical school when I was so excited about lectures going to medical school and we had a class in pathology and studying the diseases, skin conditions, and the lecturer came in with a PowerPoint and showed us varieties of skin conditions. I bet you, none was on the black skin. And for me, that’s not very vocal in class, I didn’t know how to ask my lecturer, why are these not in black skin? Because our patients are predominantly Black people, yet the resources to give to a medical student . . . none. I mean, I’m not exaggerating. None was on the black skin. It was really a problem for me because I mean, taking back in 2021, when Nigerian medical students had asked him, “How does heat rash look like on the Black skin?” They said they look reddish on the Black skin.
And that’s to say that our literature, our textbooks play a predominant role in how medical students diagnose skin condition like heat rash. And that’s to talk about my school where resources were all white-centered. And at a recent time, I decided to meet the school leadership to see how I can contribute to my own experience or probably review their teaching aids. But it’s difficult to teach doctors who already know. They never accept they know something or they don’t know something. So it’s really difficult. But I would say that predominantly our teaching resources are white-centered. Our mannequins, for example, our teaching models are all white-centered, none is Black. And I think really so much to do because talking about the research data, predominantly that affects the United States, but because of lack of data in Africa, it’s difficult to really enunciate this data among African people, among Black people because of lack of availability of resources, of data education.
And I would say one thing, the difficulty in having access to this data is not because there are no Black images, for example, there are patients who come with complaints of simple conditions and dermatologists would have photographs of this condition, but they never tend to release them for public use or for research purposes. And that can limit accessible illustrations. So these images are there, but I think in the archive of the dermatologists they’re not being accessible for educational purposes.
JOEL BERVELL: Wow. It’s so fascinating to hear how universal what we’re talking about is. The fact that it’s not just here in the United States that there’s a lack of diversity in illustrations, but even places where there’s predominantly Black people, still has this same lack of information that’s spread. And then the second thing you said that I really resonated with too is the fact that as students, the fear of reaching out to doctors and being able to have that conversation there. Are there any other illustrations you’d want to point to that you think are really powerful that you’ve worked on?
CHIDIEBERE IBE: Well, in recent times, I’ve also worked on a powerful artwork called the SCARS. I mean, it’s not a medical condition, but I called it the SCARS because a couple of times most Black people were always given alternative or cesarean section other than number of vaginal births. And if you take my Instagram, you’d see I collaborated with a full artist of mine. We did from different races, the Latinos, the white people, the Asians having the scar from cesarean section. And it was about speaking about people who have gone through cesarean section as a final alternative, who were not given options of vaginal births. And because of that, it’s also been proven that continuous cesarean section, a particular support can also be dangerous for the mother’s health. So I created a piece about the SCARS, and also I created a piece called EMANCIPATION. I mean, it’s not a medical condition, but it was about Serena Williams when she went through the racism from a nurse.
And that was to expose, I would say, or to really turn a light on the issue of disparity in health care that is not about your social status, not about your ability to afford good health care, but the fact that you have black skin, you have a possibility of facing disparity in health care from your nurse. I mean, if Serena Williams, having all the money, all the fame, had certain disparity from a nurse, then it’s possible that anyone else can also go through certain issues like that. And I think by today also, I’m going to be posting another article called “Postpartum Depression,” which from research, one in eight mothers are likely to have postpartum depression. So I think after the call, I’m just going to make that as a public post because I feel these are areas of medicine that people should talk about, about mental health, about wellness, and about understanding the pain that mothers go through from childbirth.
JOEL BERVELL: Yeah, I think both the examples are getting to something that you briefly hinted at before, the fact that you’re explicitly not investing time and resources in anatomical drawing per se, but more on symptoms and disease. Can you explain that distinction and why it’s important?
CHIDIEBERE IBE: Well, it’s very much important because anatomy, for example, the pectoralis major, the trapezoid, I mean, it’s still going to be the same anatomy for years. And I don’t think that’s going to change in coming years. And look at it explicitly, it hasn’t really solved the global problem of disparity in health care. For example, we talk about the cases of disparity in health care are skin factor, where skin has become the first basis for treatment for patients where patients are seen and heard. For example, if as a Black patient I’m ill-treated by my doctor, it’s not because my pectoralis major is prominent, it’s because my skin color is black. So considering all of the factors, it is important to identify the problem, which is key, and walk around that as a solution to solving the problem. Because looking at Frank Netter, which is a part of illustration, he has always created a lot of anatomy illustrations.
And I think that perpetuated stereotype in some perspective because they’re all white-centered. But if we are going to address the issue of disparity in health care or address the lack of visual representation in health care, we need to consider the skin as a first basis for accurate representation. In as much as I think for me, that’s just my niche that I’ve decided to have created for myself to focus on times and symptoms and skin conditions and the rest to hopefully use this major to advocate for Black people or generally the minority group.
JOEL BERVELL: Mm-hmm. And you often speak about increasing patient safety as a driving inspiration. Can you give an example?
CHIDIEBERE IBE: Well, ultimately the essence of health care is to ensure that our patients are safe, not just in terms of the patient–doctor relationship, but also safe enough to be able to talk about their personal issues to a doctor or to a physician. Because safety in general tends to cover a wide spectrum in terms of if a patient walked into the hospital, is he or she comfortable enough to talk about her symptoms or with the doctor? And if yes, would the doctor be open enough or receptive enough to listen to the patient? And all of these tend to affect patient safety because talking about visual representation . . . I mean, several of our videos, we’ve talked about how Black people have nerve endings that are less sensitive to pain. Because of this myth in health care, it’s possible that medical students who are trained, assuming that the Black patient has nerves that are less sensitive to pain basically. So considering factors like that is important to know that this can affect patient safety. So in my opinion, I believe that integrating illustrations that cover a certain population can have a great outcome in that patient safety by eliminating the bias in health care around a certain population. So I strongly believe that patient safety has a wide spectrum, but ultimately it’s focused on how patients feel or how they’re seen in the health care space.
JOEL BERVELL: Absolutely. And you’re extremely focused on updating medical curriculums globally by creating and distributing images that show people with a range of skin tones. Can you talk about some of the textbook initiatives, maybe the nursing textbook curriculum that you’re working on?
CHIDIEBERE IBE: Yeah. So currently, I’m working on . . . I and a friend of mine, Mercy, we partnered on creating a nursing textbook for boarding nursing student, and she reached out to me and said that she realized that nursing school, most of our teaching resources were all white-centered. And if you can collaborate to create more perspective in that regard. So hopefully by next year, the book will be out. But I would say regarding medical curricula, it is really difficult to reach out to faculties and tell them this is something that has been missing and wanted them to make a change. It is really a big change.
So what we do is that we begin to create these illustrations for them to see that there’s a problem somewhere. And when they see and understand, they begin to integrate in the curricular. And usually, the issue with not being able to change that because people have lack of access to these illustrations. So that’s where the Illustrative Change came in to give them access to these illustrations. Personally, I’m working on my second book, and this is also to throw a light about the work that I do and hoping that it can also create reasons for integrating this in medical curricula.
JOEL BERVELL: And I’m really happy that one, you spoke about resistance, the resistance that can occur. And then two, about that the book is for nurses. It’s not just for doctors, recognizing the full spectrum of health care and how you can’t just educate one specific specialty profession within the health care field, but it’s understanding all of it. I think you mentioned that I talk about pain biases. So many nurses will reach out to me and say that they saw inaccurate information about pain from different cultures in their nursing textbooks. And so, that’s how things get perpetuated. It’s not just doctors, but it’s all kinds of specialties within there.
You’re also currently the lead medical director at Harvard’s International Center for Genetic Disease and the chief medical illustrator and creative director for the Journal of Global Neurosurgery. Can you talk a little bit about the reach and scope of those projects and how is that work different or maybe complementary to the Illustrate Change initiative?
CHIDIEBERE IBE: Well, so for my position at Harvard, so what we did was that we had a couple of meetings and we decided to build a project called Meetup, which is a medical inclusion and diversity program, which was similar to Illustrate Change, but this is just for the Harvard community where talking about medical curricula, where there was a need to review medical curricula, we decided to give them an opportunity to have access to these illustrations. So we are going to build a digital library for the Harvard community where lecturers, staffs could have access to the library and download free illustrations for educational purpose for their PowerPoint presentations.
And being at the Journal of Global Neurosurgery, my workday is just to create illustrations and to create digital assets for the social media campaigns, for social media posts and being passionate about neurosurgery. But how it relates to Illustrate Change is that it’s still a digital library, but for different users. One is for the Harvard community, one for general use. And for illustration, I would say it’s a continuous project which we intend building the library with other illustrations and other illustrators.
JOEL BERVELL: I love that, it’s amazing. So much incredible work. You’ve accomplished so much in just four years as a medical student, but you are just one person, and you’re still pretty unique in the field. I know one of your efforts has been to build a sustainable pipeline in the profession to ensure that representation becomes a conventional part of medical illustration in the future. Can you talk a little bit more about the association of medical illustrators, and especially the recent fellowship that was created to train more artists of color, maybe some of the training that you’re doing in Zambia with your classmates?
CHIDIEBERE IBE: Well, I’m just going to start with the last one. For me, my philosophy, I would say has been that leaders create more leaders and not just followers. So I decided to say, okay, how can I create more of people who are passionate about what I do, people who are willing to also contribute? Because sometimes I receive so many requests from people to create so many artworks, so many illustrations. But there’s just little I can do as a single person. But if I have a team effort from people who are passionate about the same thing, who are working to bring inclusivity in health care through illustrations, it can really go a long way. So I started a training program in school. We started by training around 24 medical students who were non-artists.
And it was really difficult training people are non-artists and how to create illustrations, but the idea was that they were passionate about it. So I had to collaborate with other artists to teach them. Because I think it’s also a great way to promote Africa to the global stage and also to create more illustrators of my kind. And also, the AMI community has been doing a great job by integrating direct illustrators from different regions to contribute illustrations. It’s a collective effort from different illustrators who from different areas of the world who has come together and brought their expertise in building the library. And these are all diverse communities. And I think that is a great job, and that is a good way of talking about inclusivity in health care.
So I would say ultimately, my work is to produce more people, to raise more people, to encourage more people from a distance, I would say. Because I had a couple of times where people reached out to me, other hospitals who reached out to me and said that from now onwards, all the arts going to be Black-centered, I mean, not white illustrations anymore. So that’s to say to a certain degree, I’ve been able to impact people from a distance to collectively work synergistically to create more visibility in this regard. So I would say, I think I would give myself a bit of credit there that I’m doing a good job.
JOEL BERVELL: You’re doing an incredible job. And just to give a quick example of that, literally this past weekend I was in Austin, Texas, at South by Southwest. Someone came up to me and they said, “I’ve been following you for a few years.” One of my favorite questions to ask people is, “What video is it that most stuck with you?” And they immediately said, “The video that stuck with me the most was the one in which you showed a Black fetus with a Black mother.”
CHIDIEBERE IBE: Wow.
JOEL BERVELL: And I think that video, to this day, is one of the best-performing videos because it’s so powerful. I’ve always said, you can’t be what you can’t see.
CHIDIEBERE IBE: Exactly.
JOEL BERVELL: And I think the work you’re doing, the visual work you’re doing in order to change health care is truly changing lives, and at the same time is also inspiring an entire generation.
So Chidiebere, I want to say thank you so much for being on this podcast. It’s been a long time coming, and I’m so thankful for the work you’re doing and for the time you’ve given.
CHIDIEBERE IBE: Thank you so much. It’s a pleasure having this call with you. Thank you, it’s fantastic.
JOEL BERVELL: This episode of The Dose was produced by Jody Becker, Mickey Capper, and Bethanne Fox. Special thanks to Barry Scholl for editing, Jen Wilson and Rose Wong for art and design, and Paul Frame for web support. Our theme music is “Arizona Moon” by Blue Dot Sessions. If you want to check us out online, visit thedose.show. There you’ll be able to learn more about today’s episode and explore other resources. That’s it for The Dose. I’m Joel Bervell, and thank you for listening.
