Nadia Sam-Agudu was 21 when she had her first direct experience of racism. She had just arrived in the United States from Ghana in 1994, with dreams of pursuing a medical career. But a roommate at the University of Virginia in Charlottesville — a white woman — barely acknowledged her presence and wouldn’t let her use her computer or sit on her bed.

“I was treated as if I was dirty,” says Sam-Agudu. That was just the start: she experienced racism all through her US academic and clinical training. At Mayo Medical School in Rochester, Minnesota and during a residency and fellowship at the University of Minnesota, Minneapolis, she says, some supervisors gave more time and attention to white male colleagues and “barely spoke to me”. It nearly derailed her quest to improve health care for children in Africa.

She saw the difference in how she was treated compared with white colleagues. “I was the only Black African woman, so I could tell,” she says.

A paternalistic relationship

Sam-Agudu persevered and rose through the ranks. Now an associate professor of paediatrics at the University of Maryland School of Medicine in Baltimore, she also serves as senior technical adviser for paediatric and adolescent HIV at the Institute of Human Virology in Abuja, Nigeria.

The things that threaten to chip away at her confidence and resolve, however, have never gone away. “Racism makes you feel ‘less’ — like you don’t belong in that space,” says Sam-Agudu. It kills the motivation, passion and confidence that researchers need to pursue their careers, she says. And that’s why, when someone treats her disrespectfully, Sam-Agudu wonders whether they are doing so because it’s the norm in academia or because they presume a Black African to be incompetent.

When she has been involved in implementing public-health programmes across Africa, for example, some white colleagues have doubted and talked down to her, she says, and they’ve ignored the perspective and suggestions she brings. Many public-health programmes in Africa are funded by foreign donors and international organizations. “The relationship becomes paternalistic,” says Sam-Agudu. She often finds that people with less experience and less relevant credentials than herself are “talking to us in a way that infantilizes us — as if we are children”.

One instance that sticks with her was an e-mail thread in which she discussed some unpublished research with her co-authors. Sam-Agudu raised the need for them to explain the ethics approach for consent in the manuscript. According to Sam-Agudu: “All this person had to do was confirm this and state it in the affirmative.” Instead, she received a snide response that she felt belittled her. “[It] was uncalled for and disrespectful,” she says. No one on the thread replied to back her up or offer support.

Straddling two worlds

Sam-Agudu says that she is less likely to encounter such condescending responses when she uses her US affiliation in e-mails or when applying for research funding.

Madhukar Pai, associate director of the McGill International TB Centre in Montreal, Canada, describes Sam-Agudu as a “passionate advocate for a more just, diverse, inclusive and equitable global-health architecture”. He notes that she’s also reflective about her own privilege as someone with affiliations in both the United States and Africa, and is careful not to perpetrate harm against Africans in the work that she does.

African researchers can find themselves in precarious positions when they speak out about racism in encounters with funders and research institutions in the global north. But Sam-Agudu says she’s not afraid to speak up. At the same time, she admits that it can be tricky to tell the difference between constructive criticism and racist microaggressions. “It’s a lot of effort to go through this,” she says.

Thinking back to her first experiences of racism in academia, Sam-Agudu doesn’t think that much has changed: “Racism is not gone out of science; it’s still there. If you haven’t experienced it, think about the privileges you might have that may shield you from these experiences,” she says. “We shouldn’t get comfortable — it’s a systemic issue.”