OHIO, United States (AP) – The inseparable sisters always stood out – identical twins from Twinsburg, Ohio, whip-smart students from the side of town with unpaved streets and no sidewalks, excluded from the gifted track because they are black.

Their friends were white and a classmate’s comment still stings: “‘I don’t even think of you as klack.’ I said, ‘Thank you.’ And I felt pride,” Brittani James recalls, shuddering.

“I believed we were special. I believed other people in our neighbourhood weren’t as good as us,” she said.

The twins were indeed special – they won free rides to the Ivy League, earned medical degrees at prestigious universities, and have thrived in a profession where they are vastly outnumbered by virtue of their skin colour.

But their mission now is to dismantle the entrenched bigotry behind that classmate’s backhanded remark.

At 33, James and her twin, Brandi Jackson, have taken on the medical establishment in pioneering work to eliminate racism in medicine.

“We’re teaching how to see it and how to undo it,” Jackson said.

James, an internal medicine doctor, and Jackson, a psychiatrist, have developed anti-racist coursework used in two Chicago medical schools. They’ve co-founded the Institute for Antiracism in Medicine, where physicians can earn continuing medical education credit for taking classes on how their profession has made black patients sicker.

There’s more. They’re seeking federal legislation to require hospitals to reveal outcomes by race, with penalties for those where black patients consistently fare worse. They’ve helped created an online support group to help like-minded, stressed-out back doctors heal and strategise.

They’ve even hatched a plan to create black coats for doctors. That’s not as radical as it might sound – black coats were the tradition in the 19th century.

Their latest achievement? Helping lead a charge against the American Medical Association (AMA) and the influential research journal it publishes.

The twins are riding a wave and they got there by “learning to breathe underwater”. That’s how Jackson describes adapting to “this constant oppressive pressure” of racism.

“I remember being young and being told in school that I can’t be smart because of where I’m from, being told your hair is ugly,” she said. “You learn to live with the kind of pain that comes just for being. Just for walking down the street. You can’t name it when you’re that young. It does something to your psyche.”

It can break you, and Jackson and James have had fragile moments of self-doubt. But the pandemic year has fuelled their resolve. They say the relentless toll on people of colour from the coronavirus and video-documented police violence has laid bare the damage caused by structural racism.

”It is literally killing us,” James said.

In recent steps that critics labelled mostly symbolic, the AMA has made an effort to come to grips with its racial history. The group excluded black doctors from its ranks for over 100 years, and even today, just five per cent of all US physicians are black.

Within the past few years, the nation’s largest doctors’ group hired Dr Aletha Maybank as its first chief health equity officer and declared racism a public health threat. In February, it removed a statue displayed at its Chicago headquarters of Dr Nathan Davis, AMA’s founder, who promoted racist policies.

But later that month, a podcast hosted by the AMA’s flagship medical journal caused a stir. The tweet promoting the podcast read, ”No physician is racist, so how can there be structural racism in health?”

It was, Maybank said, “a gut punch”.

The sisters’ institute started a petition in response, demanding that the journal diversify its mostly white editorial staff and ensure that medical research relating to race and racism gets published. The effort has garnered more than 8,800 signatures so far.

AMA suspended the journal’s chief editor and a deputy editor resigned.

AMA also agreed to meet last month to hear demands for change from several black physicians, including James and New York cardiologist Dr Raymond Givens, another leading AMA critic.

The doctors will be looking to hear how AMA plans to address their concerns at a second meeting, but James says the AMA’s anti-racism plan – in the works long before the sisters’ activism – makes her optimistic. In an 83-page document released Tuesday, AMA vowed to dismantle structural racism inside its own ranks and within the US medical establishment with steps that include diversifying its own staff and collaborating with outside groups.

The group reached out to James and other physicians to discuss the plan – a hopeful sign, she said.

“We still have to hold their feet to the fire,” she said.

Part of the problem is doctors’ deeply embedded identity as healers and “good people”, Jackson said. “It’s hard when you’re indoctrinated in that culture to stop and say, ‘Are we really doing good?”’

A racial imbalance in medical leadership perpetuates the problem, James said those making decisions and policies don’t look like the populations they serve.

James treats patients at a clinic on Chicago’s South Side and teaches at the University of Illinois-Chicago. Jackson has taught at Rush Medical College and is the behavioural health director at a Chicago health network that treats LGBTQ and other underserved patients.

Working with students, medical residents and colleagues, they strive to highlight the harm caused by the disproven idea that there are biological differences in black people that contribute to health disparities.

Jamaica Observer