On medical racism, invisible disabilities, and how poor workplace handling becomes both race and disability discrimination.
Sickle cell disease carries a specific history. It’s inherited primarily by people of African descent, and that inheritance traces back to slavery, to survival adaptations to malaria, to the ways that survival got encoded in genetics and carried forward through the diaspora. In most Western workplaces, sickle cell disease is a uniquely Black experience. And it exists in workplaces where that history is rarely acknowledged, where medical racism is rarely named, and where Black employees managing sickle cell disease are navigating barriers that are simultaneously about Blackness and about disability, and treating them as separate is a form of erasure.
Medical Racism and the Credibility Question
Medical racism operates on a principle of systematic disbelief. Black patients’ reported symptoms are taken less seriously. Their pain is underestimated. Their illnesses are attributed to drug-seeking rather than genuine suffering. Their complaints are considered exaggerations. This dynamic doesn’t disappear when you walk into your workplace. If anything, it intensifies, because now you’re managing medical racism without the basic assumption of credibility you might get elsewhere.
A Black employee with sickle cell disease who calls in sick during a pain crisis isn’t just managing the biological reality of pain. They’re managing the assumption that they might be exaggerating, that they might be using their illness as an excuse, that their pain is somehow less legitimate because they’re the person reporting it. These aren’t overt accusations usually. They’re subtler: the tone of follow-up emails, the expression on a manager’s face, the way they’re treated differently when they return. Microaggressions are their own form of violence. They accumulate.
Sickle cell disease is particularly vulnerable to this disbelief because pain is central but invisible. No one can see the sickling of red blood cells. No one can see the tissue damage. All anyone sees is a Black person saying they’re in pain, and they have to choose to believe them. Or choose not to. The choice, when made by someone in power over your employment, has consequences.
The Weight of Visibility
There’s an additional labour that comes from managing a disease that is so specifically associated with Blackness. If you disclose sickle cell, you’re making your Blackness visible in a way that gets immediately medicalised. Your illness becomes another reason to treat you as other, as needing special consideration, as different. You’re a Black person with a Black disease, and that double signification shapes how you’re perceived.
And yet if you don’t disclose, if you try to manage it privately, you’re dealing with the consequences alone. The pain that emerges unexpectedly. The fatigue. The complications that make it impossible to show up as expected. You’re making yourself sick trying to maintain an image of wellness, trying to be the Black employee without the burden of visible illness.
There’s also the exhaustion of educating. Most of your colleagues won’t know what sickle cell is. They won’t understand that it’s not just painful—it’s progressive, it damages organs, it has serious complications. So you end up explaining your own disease to people who are supposed to be accommodating it. You’re the expert on your own body because the workplace hasn’t bothered to educate itself. You’re selling your legitimacy while managing your pain.
The Intersection in Practice
At work, you’re managing two distinct sets of discrimination operating simultaneously. The medical racism that makes your pain less credible. The ableism that doesn’t know how to accommodate pain that comes and goes, that isn’t visible, that might look like you’re managing fine until you suddenly can’t. The racism that is always present and that becomes visible at moments of vulnerability. The ableism that is waiting to pounce when you can’t perform perfect health.
You’re doing the work of managing both simultaneously. The racism that makes your pain less credible. The ableism that doesn’t provide adequate accommodation. The intersection where you’re not just a disabled employee or a Black employee. You’re a Black disabled employee managing a disease that embodies both your Blackness and your disability in ways that your workplace might never acknowledge, or if it does, might weaponise.
What Actual Support Means
Organisations that support Black employees with sickle cell disease start with the understanding that this is complex. They educate themselves about what the disease is, what the progression looks like, what pain crisis means. They don’t make the Black employee teach them. They do the work.
They believe their Black employees about pain and illness, not provisionally, not pending more proof, but as baseline assumption. They believe that when someone says they’re in pain, they’re in pain. They don’t make Black employees prove their disability harder than any other employee. They don’t interrogate whether the sick day was really necessary, whether the accommodation is really needed.
They protect their Black employees from having to explain or educate. They make space for the disease to exist without requiring performance of health or constant justification. They acknowledge that sickle cell disease is a chronic disease and that managing it at work is legitimate, necessary, and not a problem.
And they understand that this is both race discrimination work and disability accommodation work. It’s not a women’s health issue or a personal struggle. It’s a workplace responsibility.