This Black History Month, the UKKA is proud to spotlight the voices and experiences of Black professionals in our kidney community. We spoke with Catherine Maina, a dedicated Kidney Nurse Specialist, about her journey from nursing in Kenya to navigating the UK healthcare system. Catherine shares her reflections on the importance of representation, the unique challenges Black nurses encounter, and her commitment to fostering equity and cultural understanding in kidney care. Her story underscores the diverse strengths within our community and highlights how each voice contributes to advancing kidney health and inclusive care in the UK.
What inspired you to choose this path into kidney care?
I hope you have time because I will tell you a story! The year is 2016, and I am a nurse-midwife in Kenya. For context, Kenya is one of the countries in the world where they train nurses in all aspects of adult, paediatric, community, district and maternity health. When we qualify from a nursing school (whether with a Diploma or Bachelor of Science Degree in Nursing), we can be posted to any department. I was in the maternity wing. I admitted an 18-year-old who had never attended antenatal care. She was 32 weeks pregnant, and I was her first contact with maternal care. We admitted her because she had what looked like premature labour. I admitted her on a bright Sunday afternoon and had a day off on Monday.
On Tuesday when I returned to work, I naturally followed up on her whereabouts. I sadly learned that she had been referred to a more specialised hospital after seizing due to eclampsia. She died in the waiting room from acute kidney failure as we called it back then. I felt devastated. I went back to my notes. What had I missed? How come her blood pressure on admission was 120/82mmhg (I will never forget this figure), yet she ended up with eclampsia? Why did kidney failure take her life? She had protein+1 in her urine on admission, was this more? What if we had the resources to carry out a kidney function test? A liver function test? Might we have noted the eminent eclampsia? I have never felt more defeated as a nurse. I mourned her. I cried every day after work that week. I prayed for her soul. I wished I knew more about kidneys and how to help such mothers.
As if on cue, the hospital nurse manager the following week called me to her office and had a discussion about advancing my education. She had three chances for nurses to pursue nurse anesthesiology, critical care, or nephrology nursing at a Higher National Diploma level. I opted for nephrology nursing. I saw it as an answer to my prayers. This is how I went back to college and for a year studied nothing but nephrology nursing. Kenya offers these specialized courses as a national nursing curriculum as opposed to standalone modules which we do here in the UK. That was my entry into nephrology nursing.
How important is representation of Black professionals in the healthcare sector, particularly in kidney care?
Until I came to the UK and fully immersed myself in the kidney stratosphere, I never thought about representation as a Black girl. Yet when I worked as a Clinical Nurse Specialist in the advanced kidney care unit, I came face to face with grim statistics of patients from ethnic minorities and how reluctant they were to engage with the services we offered. It was such a deep contrast to see how many of them had an unplanned start to dialysis and even fewer had successful kidney transplants! I started being more deliberate in reaching out to ethnic minority patients, especially Black patients of Afro-Caribbean ethnicity. I tapped into our shared cultural nuances and beliefs about healthcare and health-seeking behaviour. I was pleased to see them embracing peritoneal dialysis, some agreed to vascular creations among other positive outcomes.
I believe that Black kidney nurses need to take up a more frontline approach to kidney health delivery in the UK. This strengthens cultural competence of the team and helps the patients develop a more engaging relationship with the services we offer. All these concerted efforts can help reduce the NHS CKD burden.
What are some unique challenges you’ve faced and how have you navigated these challenges - what advice would you offer young Black professionals entering this field?
The UK’s healthcare infrastructure is a jigsaw puzzle to any overseas nurse like myself. I struggled to understand it - and believe you me, even today, I still do not fully grasp it. How I manage this is to engage with national associations like the UKKA and the Association of Nephrology Nurses. The conversations there help me understand the structure of the system and how kidney health is impacted by a wider organisational structure. I encourage my colleagues to tap into these associations and embrace opportunities therein.
The other challenge I face is the subtle non-answers from the British culture as a whole. The response to many things is to smile politely which I find can be quite misleading because I come from a culture where we say what we mean and seek to improve situations. It’s misleading in the sense that someone can be truly unhappy, but to maintain the status quo they smile politely and say or do nothing - but spend the rest of the day grumbling in the staffroom! How I manage this is to ask for genuine reactions. More often than not, I find that people speak up when they know you have created a safe space for them to react or act. Only when we know the ‘What’ can we address the ‘How.’
Finally, I would like to bring attention to a lesser-known type of racism in the kidney world in the UK. In addition to the more common White-on-Black racism, there is also discrimination from colleagues within the BAME community working in renal units (dialysis, renal wards, etc). We do not address this enough because it can feel difficult to explain - how can I claim my fellow overseas nurse is discriminatory against me as a black nurse? Who will believe me? This ails many and they shy away from the kidney world in the UK.
I encourage Black renal nurses to know that they are not mistaken for seeing the discrimination against them. It is disheartening that we have to constantly assert our right to exist and work in specialised departments. I challenge every renal directorate this Black History Month to truly investigate how many Black nurses they give opportunities to.
Looking ahead, what changes or initiatives would you like to see in the kidney community to foster more inclusion and equity?
We need to discuss our healthcare inequality among various races more openly. We must get comfortable with this conversation. This is how we start addressing health inequalities in kidney care. It is true that CKD ravages Afro-Caribbean people more than their Caucasian counterparts. We have data to prove this thanks to our wonderful UK Renal Registry. It is also true that Afro-Caribbean patients do not donate kidneys as much as their Caucasian counterparts. This is also a fact. These facts are as deep as the colour of our skin. Once we create room to address this, then we can involve nurses from these communities and give them the mentorship they require to reach out to these vulnerable populations.
Before that happens, in my own capacity, I believe in continuing the kidney health talk on social media. This is how most people get their health information nowadays. Most people use social media for reference. We all know that this is wrong but social media doesn't care what we think. The only option we have therefore is to use whatever platform we have in our hands to reach out to the Afro-Caribbean population with some useful, simple information about kidney disease. I will continue using my social media to do this. That is what I have, so I will use it. What do you have?
What does Black History Month mean to you as a healthcare professional, and how do you think it can be more impactful within our community?
Since I came to the UK a few years ago, this is the first year I have truly reflected on this question.
Black History Month in 2024 reminds me of Mary Seacole and her commitment to the UK’s healthcare system alongside and yet distinct from Florence Nightingale. It reminds me of the parallel stories of Mary and Florence and how the merging of their stories should be reflected in every nursing leadership role.
Black History Month is about recognising that our patients may all be in the same sea but not in the same boat. As such, we make concerted efforts to reach out to those whose boats are nearly capsizing in the sea of kidney disease. We call out to them using voices familiar to them. We reach out to them by beating drums familiar to the beats of their hearts. We light up a beacon of hope and give it to a messenger that looks like them. We then welcome them to the vast NHS kidney care services and deliberately guide them along kidney replacement therapies including conservative care. It means we listen to them. We acknowledge their fears, distrust of the system, cultural variances and with compassion, discuss shared values and encourage their participation in shared decision-making.
Now that is how I see Black History Month creating impact within the Kidney Community in the UK and beyond.
Check out Catherine's YouTube channel where she discusses healthcare, common issues for healthcare workers, opportunities for nurses, education and medical conditions explained in simple English.