Structural racism in an urgent care unit of a northern Rio de Janeiro municipality

Introduction:   Macaé, a municipality in Northern Rio de Janeiro marked by a history of slavery and successive processes of favela formation, presents intense socio-spatial segregation between its northern and southern regions, impacting access to healthcare for Black and peripheral populations. This article offers a racialized and intersectional analysis of medical students’ practical training experiences in an urgent care unit (UCU) located in the northern region of the municipality, guided by the trajectory of a Black, peripheral medical student.

Experience Report:   This is a qualitative experience report grounded in a cartographic field diary and experiential narrative frameworks. Four on-site activities were carried out at the UCU, accompanied by tutorial supervision. The scenes described revealed: racial hierarchization among health workers; incomplete and inadequate documentation of the race/color field; recurrent use of the expression “vulnerable people” and repeated association of the predominantly Black users with violence and criminality; as well as the impact of these narratives on students’ construction of stereotypes, including the presumption of criminal involvement in ambiguous situations.

Discussion:   In light of the concept of structural racism and literature on urban segregation, whiteness, and the hidden curriculum in medical education, the UCU is interpreted as reproducing institutional violence by erasing racial data, dehumanizing Black users, and normalizing discourses that reinforce inequities. Such practices operate as implicit pedagogical messages, shaping students’ identities, perceptions, and attitudes.

Conclusion:   The study highlights the persistence of structural racism in Macaé’s healthcare services and underscores the need to improve the collection of racial data, strengthen racial literacy, and provide pedagogical and anti-racist training to health professionals who function as preceptors. The findings suggest the importance of further investigations into the relationship between race, healthcare organization, and the implementation of the National Policy for Comprehensive Health of the Black Population in peripheral contexts.

Keywords:
Systemic Racism; Education, Medical; Health Inequities; Attitude of Health Personnel; Public Health