Medical Woman - Vol 41, Issue 1 - Spring/Summer 2022

W EDICAL W MAN

VOLUME 41: ISSUE 1

SPRING/SUMMER 2022

The Inspire Issue www.medicalwomensfederation.org.uk

Editor’s Letter Inspiring and Exploring

I

t has been a tumultuous two years. How did you spend yours?

We have cycled in and out of lockdowns, engaged in debates centred on health, and ridden a rollercoaster of restrictions.

Some of us might have retreated into a quieter place, while others will have found our voices.

As Spring edges its way in and Summer soon to follow, I too have been edging my way back in to practicing normality, practically and psychologically. It has been a busy start to 2022, the new year brought with it a move into another clinical rotation, and renewed hopes for the future, as well as a strong desire to explore. As the weather looks up, as we connect face to face, and the world busies up again, there is inspiration to be found in many places.

The theme of this issue is inspiration, and I hope you will find plenty amongst the pages.

In our career planning article, we kick off with perspectives from the world of Orthopaedic surgery, and Samantha Tross describes her experiences as the first black Orthopaedic surgeon in the UK. In our Skills Toolkit and Career Planning articles we focus on tips to form successful societies and establishing networks. In this issue, we journey into the worlds of expedition medicine and global health, with fantastic articles designed to provide tips on how to get started on your adventure.

The Unwind section hosts some inspiring creative content from medical women and also covers the often overlooked topic of doctor carers.

I hope this issue provides you with a selection of thought provoking articles to share with family, friends, and colleagues. I look forward to hearing from you - my contact details are below.

Fizzah Ali @DrFizzah @drfizzahali Fizzahali.editoratmwf@gmail.com

Contents Medical Woman, membership magazine of the Medical Women’s Federation

MWF at 105

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Editor-in-Chief: Dr Fizzah Ali fizzahali.editoratmwf@gmail.com

News and Events

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Editorial Assistants: Miss Katie Aldridge Ms Danielle Nwadinobi

A day in the life of an: Orthopaedic surgeon

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Design & Production: Toni Barrington The Magazine Production Company www.magazineproduction.com Cover illustration: Pexels Articles published in Medical Woman reflect the opinions of the authors and not necessarily those represented by the Medical Women’s Federation.

Medical Women’s Federation Tavistock House North, Tavistock Square, London WC1H 9HX Tel: 020 7387 7765 E-mail: admin@medicalwomensfederation.org.uk www.medicalwomensfederation.org.uk @medicalwomenuk www.facebook.com/MedWomen Registered charity: 261820 Patron: HRH The Duchess of Gloucester GCVO President: Professor Chloe Orkin President-Elect : Professor Scarlett McNally

5 Skills toolkit: running a successful society

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Career planning: building a network

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Feature: Expedition medicine

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Feature: Global heath

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Spotlight: Waves of interest

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Creative entries

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Unwind: The poetry of doctor carers

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Book review: My name is why

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10

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Vice-President: Dr Nuthana Prathivadi Bhanyankaram Honorary Secretary: Dr Anthea Mowat Honorary Treasurers: Dr Rashmi Mathew Dr Angharad Ruttley

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Medical Woman: © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without the prior written consent of the Publisher. A reprint service is available. Great care is taken to ensure accuracy in the preparation of this publication, but Medical Woman cannot be held responsible for its content. The views expressed are those of the contributors and not necessarily those of the Publisher.

Medical Woman | Spring/Summer 2022 1

MWF AT 105

The Medical Womens Federation at 105 The Medical Women’s Federation (MWF) was founded in 1917 with 190 members and Dr Jane Walker as President. As of the 1st February 2022, MWF is 105 years old and continues to have a major influential voice addressing important issues within the medical profession. We would like to thank all our members who have continued to support us to be the ‘voice of medical women on medical issues’.

For Women’s History month, we have chosen to celebrate our past presidents using important quotes from them.

You can follow the campaign on MWF social media using the #celebratingmedicalwomen

Dr Sally Davies, MWF President 2014-2016 “Know which battles to fight. You set the culture.

If you know where you are going, the team you are leading then knows what they are working towards.”

Professor Henrietta Bowden-Jones, MWF President 2018-2020 “My favourite memory of the Medical Women’s Federation is dancing a Scottish jig with Professor Dame Parveen Kumar! The photo pops up on Twitter now and then and makes me smile.”

Professor Dame Parveen Kumar, MWF President 2016-2018 “Being a doctor is jolly hard work but make sure you have fun! Have a hobby.”

Professor Neena Modi, Immediate MWF Past President 2020 – 2021 “I wish I had been more confident. Women have been so marginalised over the ages which has left a deep, scarring legacy. Confidence in a girl or woman is seen as ‘pushy, aggressive, bold’. With each generation there is less of this stigma which is great but it’s not quite gone yet.”

Professor Chloe Orkin, current MWF President “I wish I had known that having a community of women was so important. Make sure your voice is about medical issues and you don’t get pigeonholed into talking about women’s issues.”

Dr Melanie Davies, MWF President 2006-2007 “You lead from the front; you don’t tell people what to do if you wouldn’t do it yourself.”

Ms Sue Ward, MWF President 2007-2008

Dr Helen Goodyear, MWF President 2008-2010

“The Medical Women’s Federation capitalised on the CMO being interested in medical women and we set up a working group chaired by Baroness Deech.”

“Enjoy medicine and channel your career into the areas you have a passion for.”

Dr Clarissa Fabre, MWF President 2010-2012 “Fit your life around what you want to do, you will have to adapt on the way but do have a very fulfilling life in terms of career and other things you want to pursue.”

Dr Fiona Cornish, MWF President 2012-2014 “Take opportunities. Say yes rather than no. Don’t worry about being underqualified by a post. Learn to do things on a good enough basis.”

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MWF AT 105 Baroness Illora Finlay, MWF President 2001-2002 “Realise you are always learning; you will never, ever know it all. Things are moving so fast in all branches of medicine, you will always be running to keep up and you will never quite get there!”

Professor Bhupinder Sandhu, MWF President 2005-2006 Dr Fiona Subotsky, MWF President 1999-2000 “My mother had been a long-time member of the Medical Women’s Federation, so it was natural for me to follow in her footsteps, and I strongly support the idea of honouring ‘foremothers’.”

“Copy good role models, bits from this and bits from that.

You are only as good as your team. Develop your team and go out of your way to know them as people rather than as just colleagues.”

Dr Judith Chapman, President 1995-1996 “Always present possible solutions to problems and never simply complain about things being wrong.”

Dr Gill Markham, MWF President 1993-1994 “The Medical Women’s Federation provided a nonjudgemental and rather nice audience in which to learn to chair a meeting and have the confidence to speak in public.”

Professor Wendy Savage, MWF President 1992-1993 “I was able, with the help of a group of friends, to set up the Elizabeth Garrett Anderson for Women and we worked to preserve the Elizabeth Garrett Anderson Hospital which I managed to get listed at the second attempt.”

Dr Pauline Brimblecombe, MWF President 2002-2003 “Know the extent of your circle of influence.

You need to adjust your leadership approach to different situations and audiences.”

Lady Barrett, MWF President 1922-1924 Described by her colleagues “Her public speaking was always wise and broadminded and showed an understanding of other nations’ views. Her integrity, leadership and generous personality are qualities for which she will long be remembered.”

Dr Jane Walker, MWF President 1917-1920 “The work of medical women is becoming daily more needed and more appreciated, and in view of the call on the whole profession it is felt that every means should be taken to organise such work, in the interests of medical women, of medical men, and of the nation as a whole.”

Professor Selena Gray, MWF President 2004-2005

Dr Melanie Jones, MWF President 2003-2004 “You have to understand the ethos of the organisation and a clear vision of what is important to the organisation and what is important to you. It’s so important to lift as you climb. Tap your junior colleagues on the shoulder and say ‘I think you could do this’ because lack of self belief holds us back.”

“What I am most proud of during my time as Presdient is raising the issue of gender disparities in academic medicine.”

Dr Fleur Fisher, MWF President 1996-1997 “I wish I had known earlier in my career that it is very important to manage upwards in your organisation as well as looking outwards.”

Dr Joan Trowell, MWF President 1998-1999 “Take opportunities; they may not come round twice.”

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NEWS AND EVENTS

Venturing into the engine room of the MWF Danielle Nwadinobi is the Communications and Administrative Officer at the Medical Women’s Federation.

At university, my undergraduate degree was at the University of Plymouth, where I studied Sociology and International Relations.

I also have a masters from the School of Oriental and African Studies (SOAS) in Violence, conflict, and development.

I embarked on volunteering with UNIFEM now UNWomen in the UK as well as the International Fellowship of Reconciliation (IFOR) in the Netherlands.

Before I started at the MWF, I worked in Nigeria at an AntiCorruption agency. It has always been my dream to work with Civil society or in the development sector and therefore, I warmly welcomed the move to the Medical Women’s Federation.

At MWF, I oversee communications and administration. I am the first point of contact to all MWF members. My role is exciting and people - oriented as I handle requests, queries, membership, competitions, subscriptions, the MWF newsletter, editing of Medical Woman and MWF event planning and event registrations. In this role, I also handle the MWF social media and graphic design which is a boost to the creative part of me.

I have been with MWF since April 2019, and it has been quite an enjoyable and rewarding experience. I have gained valuable insights from the rich history and organisational culture of MWF. Engaging with the members individually and as a community of practice has been quite enthralling.

The opportunity to meet and connect with people and doctors from all walks of life is fascinating. One of the most remarkable things about MWF is the family feel to the organisation. I recall attending my first conference in Bristol where I was welcomed warmly, and it was a delight to sit down and enjoy some interesting exchanges on diverse topics with the MWF members at the informal dinner.

Despite the fact that I was meeting them for the first time, I left there feeling like I had known them for quite a long time.

MWF is very noble Association and has a lot of potential to be a significant voice in all aspects of development and especially in the field of medicine. This is an aspect which I am happy to be a part of.

It is lovely to be featured in Medical Woman. My profound thanks go to the Honorary Secretary, Dr Anthea Mowat for suggesting we introduce ourselves to the members through this medium.

My thanks also go to Dr Fizzah Ali, Medical Woman Editor for supporting our input to this edition.

I look forward to meeting members at our next in person conference in November.

I invite you to please get in touch with us at central office for any suggestions and if you have any concerns as we look forward to hearing from you our valuable members.

Katie Aldridge is the Executive Officer for MWF. I joined MWF in November 2019 and have spent most of this time working 4 Medical Woman | Spring/Summer 2022

Photo by MWF president Prof Chloe Orkin at the MWF Central Office, London

from home throughout the COVID-19 pandemic. I grew up in the town of Tiverton in Devon and I have a degree in Geography that I gained from the University of Portsmouth. I have previously worked as an administrator at an adult learning centre in Exeter and as a Projects Officer for a Housing Association in London.

Whilst working in this role, I completed the Charityworks Graduate Programme where I gained insight into how charities operate.

This programme inspired me to pursue a job within the charity sector and work for an organisation that is working towards societal change.

Spring is a somewhat busy period in the MWF office. It is the time of year where MWF’s finances are audited, and our annual report created. I have spent the last few months assisting the accountants with this process by making sure our financial records are up to date, creating financial reports and answering any queries they may have.

Once the reports are finalised, I will need to update both Companies House and the Charities Commission with this information and ensure they are aware of any changes to the trustees of MWF. The spring council meeting and AGM took place in April and it was lovely to virtually see many of our members. Prior to the meetings, I collated reports from all our representatives for the Annual Review.

I very much enjoy reading everyone’s reports and it is great to see what activity has taken place over the last year.

Other parts of my role involve writing statements on behalf of MWF; preparing agendas for meetings; helping with the editing of Medical Woman; managing direct debit subscription claims; updating Quickbooks; and attending meetings with external organisations.

I also co-ordinate and help plan the Spring and Autumn Conferences. Like most organisations, MWF has had to adapt the way we hold events due to the pandemic. We have successfully hosted three virtual conferences now and I have enjoyed learning how to do this. I love listening to the inspiring speakers we have and, even though I am not a medic, I have found these very fascinating.

Despite working for an MWF for over two years, I have yet to attend an in-person MWF conference, so I am very much looking forward to the Autumn Conference in Nottingham and hope to see many of you there.

NEWS AND EVENTS

Onwards, upwards I hope you are all keeping well! I am writing this at a time when the pandemic has reached its two-year anniversary and war is being waged. However, I am determined to interject some optimism and hope! Spring is my favourite time of year; I love being outdoors looking at flowers and blossom.

They say time flies when you are having fun and the first year of my Vice Presidency has certainly zoomed by; and my goodness it has been incredibly fun! Some of the highlights are: • Our virtual Autumn conference 2021 featured some very interesting talks on advocacy, wellbeing, history of women and some brilliant abstracts from medical student and junior doctor members.

• We have responded to Government consultations on pensions, flexible working, medical devices and are currently responding to consultations on the 10-year cancer plan and clinical trial strategies.

• Dr Jasmine Thomas and Professor Neena Modi continue to work with other organisations on our parental leave campaign • Professor Chloe Orkin has been forging links with organisations such as the Worshipful Society of Apothecaries, Royal Society of Medicine, Academy of Medical Sciences, BAPIO and Melanin Medics – we have lots of exciting upcoming joint meetings!

• We have three new Officers joining the Officer team. Professor Scarlett McNally is our new President Elect and we have two new Treasurers Dr Rashmi Mathew and Dr Angharad Ruttley • Thank you to the wonderful Dr Heidi Mounsey for being MWF Treasurer for six years; it has not been easy task when our funds have been very low!

February 2022 marked 105 years of the Medical Women’s Federation and we launched The Medical Women Podcast in celebration of this birthday.

Within four weeks we had over 400 listens from five continents which is just incredible. I am thoroughly enjoying hosting and producing and I am delighted that listeners have found the episodes interesting and inspiring. The aim of the podcast is to support and empower as many medical women in their careers as we can and I hope that it is meeting this aim.

I am writing this during the first week of March when I have just had my first visit to the MWF Archives at the Wellcome Library. I really enjoyed looking through minutes of the first meetings and finding plans for a Book of Memory commemorating the founding members and Presidents of MWF. Looking at this document, it’s clear that the medical women in 1948 were keen for their successors to know how hard the pioneering first medical women worked, and how much they paved the way for future medical women. Ms Jenna MacKenzie, our wonderful podcast editor, and I are currently putting together the special International Women’s Day compilation episode which is a tribute to the 80 Presidents of the MWF; for an organisation to survive 105 years, its leaders have needed to ensure that the organisation remained relevant, continued to campaign and remained the largest body of women doctors in the UK. All of the Past Presidents who are still with us have contributed to the episode, sharing their advice and their favourite MWF memories. We will also be making a video so watch this space!

I am really looking forward to our first in person events since the pandemic, for IWD and our Autumn conference. I hope to meet lots of you in person over the coming months.

Dr Fizzah Ali always does a fantastic job with Medical Woman and I hope you enjoy reading this issue as much as I know I shall!

Dr Nuthana Prathivadi Bhayankaram MWF Vice President

Seeing Chloe for the first time since we took up Office

Minute book of the first meetings of the

MWF

By the grand staircase at The Worshipful Society of Apothecaries

Looking through the MWF archives at The Wellcome Trust

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A DAY IN THE LIFE OF:

A day in the life of: an orthopaedic surgeon Samantha Tross is a Consultant Orthopaedic Surgeon based in London. She graduated from University College London and Middlesex School of Medicine. Her basic surgical training was on the Royal London rotation and higher surgical training on the South East Thames rotation via Guy’s & St. Thomas’s hospitals. She undertook sub-specialisation fellowships in Toronto, Canada and Sydney, Australia, before taking up her Consultant post.

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CAREER PLANNING: ORTHOPAEDIC SURGERY

Can you tell us a bit about yourself?

My name is Samantha Tross and I am a Consultant hip and knee surgeon practicing in London, currently Lead Surgeon at Ealing Hospital. On appointment in 2005, I became the first black female Orthopaedic Consultant in the United Kingdom.

I was born in Guyana, South America to Afro Guyanese parents.

I arrived in England aged 11. My parents sent myself and siblings to boarding school in England to benefit from what was considered a better education system. Interestingly, the Guyanese education, based on the British system was superior in subjects such as Maths and English but did not offer the breadth of subjects.

Guyana is the only English-speaking country in South America.

The majority of people are those of Indian and African origin. The rest made up of people of mixed heritage, native American Indians and one percent of European and Chinese. Hence at a young age I was exposed to people looking like me in positions of authority and therefore never believed my colour would prevent me from achieving success.

“What I love about my job is the ability to have a significant impact on someone’s life over a short space of time as patients quickly show significant improvement in their quality-of-life following surgery.”

Why did you decide to do surgery?

At age 7, I made a declaration to the family that I would become a surgeon when I grew up. I can’t remember why I made that decision but my mother was a nurse and I had visited her in the hospital as a child. In addition, I witnessed the death of elderly relatives and was exposed to the death of childhood friends. I was also an avid reader and may have read about being a surgeon, as I declared I would be a surgeon, not a doctor! Fortunately, the desire remained although I did consider other medical careers during my training. Ultimately, I chose surgery because I loved and excelled in anatomy and the direct impact of the surgeon’s intervention could be quickly seen. I settled on Orthopaedics, as the first female surgeon I met was an orthopaedic surgeon, the orthopaedic surgeons were the friendliest of the surgeons I encountered. There is something for everyone in the speciality from use of fine motor skills to more physical surgery. You utilise your medical knowledge and unless you work in a trauma centre, most surgery takes place in respectable hours.

Describe a typical day as a surgeon The work of an orthopaedic surgeon is divided into elective and trauma services. I am responsible for patients admitted as emergency admissions (mainly fractures) once a week and during scheduled weekends. I am in charge of their care, which may be non-operative or operative. Patients are monitored

post-surgery on the ward and subsequently in my clinics. Patients may also be referred to me by their General Practitioner for hip and knee surgery. I assess them in clinic, decide the best course of treatment based on their symptoms, clinical findings and investigations. If requiring surgery, I consent them about the benefits and risks of surgery and place them on my waiting list.

Following their operation, if indicated, I will monitor their progress in clinic. I am also responsible for teaching the junior doctors and medical students in my department as well as managerial tasks such as attending meetings to plan the service provision of the department. There is also the opportunity to take part in research and publication of papers.

What do you enjoy most about a career in Orthopaedic surgery?

What I love about my job is the ability to have a significant impact on someone’s life over a short space of time as patients quickly show significant improvement in their quality-of-life following surgery.

What are the challenges in your chosen career path?

The speciality of Orthopaedics lacks gender and ethnic diversity although there are currently initiatives to address these. Female consultants make up 6% of the consultant body. Data on ethnic diversity has not historically been captured.

The Royal Surgical Colleges, Cultural and Diversity Committees within the surgical sub-specialities, individual ethnic, and other surgical associations are all working towards achieving equity and inclusion in surgery. Despite these challenges, orthopaedics remains a very competitive speciality as those wishing to pursue a career outnumber the posts available. The other challenge is the time commitment required to train in the speciality, which from medical school to consultant post currently takes around 11-12 years.

“...anyone wishing to pursue this career, I would advise they go for it.”

What advice would you give to medical students and trainees deciding on their future career path?

For anyone wishing to pursue this career, I would advise they go for it. It is a wonderfully rewarding and interesting career. I recommend joining surgical societies at university, which will give exposure to the different surgical specialities available, arranging a taster experience in your chosen speciality, getting involved in local audits and research to improve chances of being selected on what is a competitive training programme and if possible, securing a mentor. The Cultural and Diversity Committee of the British Hip Society, which I am a part of, offers mentorships to anyone from medical school to consultant level. Contact: mentorship@britishhipsociety.com for further information.

Mentorship can also be achieved via the British Caribbean Doctors and Dentists Association or newly formed British Association of Black Surgeons.

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CAREER PLANNING: ORTHOPAEDIC SURGERY

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CAREER PLANNING: ORTHOPAEDIC SURGERY

Becoming the first black female Orthopaedic Surgeon in the UK came as a surprise. I was not aware there were no others before me when I chose this career path. I just followed my passion.

Becoming the first black female Orthopaedic Surgeon in the UK came as a surprise. I was not aware there were no others before me when I chose this career path. I just followed my passion. I’m glad I wasn’t aware as the burden may have weighed me down. I was lucky to score another first in 2018, becoming the first woman in Europe to perform a Mako robotic hip replacement.

Although I had no role models that looked like me, I was fortunate to have many mentors and sponsors in my career.

These came about due to the passion I had for the profession and my hard work which was noted. My mentors gave me invaluable advice that enabled me to navigate the career path, such as ensuring I bolstered my training post application by publishing audits and articles and presenting at local and regional meetings. I also attended many academic meetings in my free time and being the only person looking like me there, I got noticed. I did experience negativity, racism, inappropriate advances and micro-aggressions but such experiences were fortunately less common than the positive support.

My experience of coming to England at age 11, separated from my siblings, parents and culture made me fiercely independent, self-reliant and resilient. I also became normalised to being in the minority, where before growing up in Guyana, I was used to being surrounded by people looking like me.

These very experiences and the character strengths I developed, are what assisted me in pursuing a career in orthopaedics. In orthopaedics, women are in the minority and so are ethnic minorities, particularly those of African and Caribbean origin.

Whilst at medical school, I was the only black female in a class of over 200 students. There was one other UK schooled black boy and a handful of exchange students from Malawi.

The year above had one black female and the year above that, one black male.

The journey has at times been lonely and I made a decision at medical school to do what I could to enable other black children to pursue a career in medicine and perhaps surgery. I have

therefore, for the last 19 years, spent time doing just that by regularly attending school career days either independently or more recently via charities such as Urban Synergy, Tomorrow’s Leaders and Powerlist Foundation, now called Arete. I speak regularly at various surgical societies and am a member of the British Caribbean Doctors and Dentists Association as well as founder member and Trustee of recently formed British Association of Black Surgeons. These organisations offer mentorship and support to medical students and doctors. The Royal Surgical Colleges as well as surgical societies have also taken on board the need to increase diversity in the specialty and I am a member of the Cultural and Diversity Committee of the British Hip Society as well as the International Orthopaedic Diversity Alliance, which are both actively engaged with this important work.

I have received numerous awards for my personal achievements and this work, such as a Black Business Award (STEM) in 2016, WinTrade Woman in Public Sector Award 2019, Black Women in Care Pioneer Award 2021 and Zenith Global Special Recognition Award in the same year. I have also been featured in the UK Black Powerlist of 100 most Influential Black Britons since 2011, featured in numerous books and invited by Sadiq Khan to give the Mayoral Address at his Black History Month event in 2019.

The journey has at times been lonely and I made a decision at medical school to do what I could to enable other black children to pursue a career in medicine and perhaps surgery.

Orthopaedics is a wonderfully rewarding, interesting and stimulating speciality, and I’m fortunate to be able to play my part. The landscape is changing and becoming more diverse and inclusive and I encourage all, particularly those from under-represented backgrounds to consider it as a career. Sure, obstacles may be encountered on the way but those should be viewed as opportunities to grow and effect change. More diversity is required to better treat our communities, effect more creativity in decisions that affect all patients and promote inclusive environments where all can thrive, so please consider joining me.

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SKILLS TOOLKIT: RUNNING A SUCCESSFUL SOCIETY

Making an impact: running a successful society Akshara Sharma is a 4th year medical student at Aston University and the Medical Women’s Federation (MWF) Student Representative for Aston University for the past two years. She has recently been appointed the new MWF Student Representative on Council. Akshara is determined to continue MWF’s work on amplifying women’s voices in the medical field, increasing opportunities, breaking down barriers and misconceptions. She has interests in leadership, management, medical education, and surgery.

Marguerite O’Riordan is a third-year medical student at Aston University. She is keen to narrow the gender gap that pervades throughout many specialties in medicine. She believes that medics at all grades, from student to consultant have a viable role to play in striving to narrow this gap, and it can be done. She has interests in medical politics, global health, trauma and orthopaedics.

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SKILLS TOOLKIT: RUNNING A SUCCESSFUL SOCIETY Creating a vision: identifying problems and having purpose The Medical Women’s Federation (MWF) is the largest body of female doctors in the UK and as the University society branch of the MWF as well as the student representative for Aston University for the past two years, we aim to strengthen and amplify medical student’s voices as they progress through their individual medical journeys. The majority of applicants and offer holders to medicine are female and an opposite trend is seen in surgical applications where the majority are male. Accordingly, societies like ours aim to narrow this gap and motivate students and give them realistic insights into the journeys of several successful female doctors. Not only this but also break down existential barriers and misconceptions that may serve as influential factors. Another important development of the MWF University platform and society is to strengthen inter-student support and students’ personal and professional development using this platform where there is a vast opportunity for students to learn from the experiences of various motivational and successful speakers.

Successful events and diverse speakers Over the past two years, we have organised and hosted several successful MWF events nationally. Our main events have been the first National Women in Medicine and Surgery event where two eminent speakers, Dr Fizzah Ali and Dr Karishma Chandarana were invited to have a panel discussion on their careers. It was attended by students from various universities across the UK and internationally. Most importantly, the event demonstrated a positive impact. By the end of the event more than 90% of the participants agreed that post-event, in their perspective, work-life balance, having a family and a medical or surgical career was possible and that they could manage this well, whereas before the event 79% to 81% of attendees thought that it was difficult to balance these two aspects. More than 70% of attendees also believed that the mentorship gap was bridged via such events and all attendees wanted to see more events like these in the future.

This academic year, we hosted three successful events with the first being on Women in Leadership. We invited four speakers from different medical specialties to share their experiences, strategies, and how they achieved reputed leadership and management roles. Our feedback from the event reflected that attendees found the speakers to be highly inspiring and motivational role models.

It increased their confidence in believing that they could achieve similar roles as well if they had the determination and commitment.

It was encouraging for the participants to hear that it was possible to be a woman in a leadership role as well as have a personal and family life. Additionally, having a view of the speaker’s challenging experiences was relatable for the attendees as often, as students, we do come across similar events but might not know how to tackle such situations. Students felt that they appreciated hearing relatable real-life experiences of speakers, it truly inspired them and gave them an idea on how to pursue similar career interests.

Another event was an Instagram live with a surgical doctor which also received positive feedback. We were able to showcase positive insight into the life of balancing multiple roles and breaking down outdated perceptions proving and again encouraging students to know that their aspirations should not be moulded because of preexisting misconceptions. The action of applying for and persevering with Core Surgical Training is preceded by building up not only an ample portfolio on paper, but also strong mentality, passion, and

resilience in the face of adversity, challenges and setbacks, and motivational factors to avoid burnout and keep you interested in what you enjoy. All of this is preceded by a medical student’s innate determination to achieve and strive for perfectionism. This might be misportrayed as often the challenges and hardships are not celebrated or spoken about. Hence, the atmosphere, mentors to look up to and learn from, and examples from medical school are of utmost importance which necessitates the goal of MWF Chapters.

It would be remis of us not to mention our national conference in March 2022. We have a range of speakers, including MWF’s President Elect, Professor Scarlett McNally. Our speakers ranged from those vocal about doctors’ mental health (Dr Ally Jaffee), financial know-how in medicine (Dr Cyra Asher), to Dr Latifa Patel, who demonstrates how our female colleagues can act as allies in striving for gender equality and activism. We hope that the broad range of interests and achievements from our panel inspires female medics to pursue their passion fearlessly; get involved in activism and realise that they have the potential to make a difference.

Employing social media We have spent years raising awareness of MWF’s work, achievements, and goals on our local Aston MWF Twitter account as well as university newsletters and group chats. We have also encouraged MWF membership benefits locally and have advertised flyers and posters on socials of Aston Surgical and Medical society.

Thanking contributors and thoughts for the future All in all, it has been a great pleasure and an enjoyable experience to be the Regional MWF Student Representative for Aston University as well as grateful to be on the Aston MWF Society’s Committee.

We are grateful for the continued support of our work by all the speakers and the Medical Women’s Federation. We couldn’t have done it without them.

Through Aston MWF society and being the Regional Representatives for Aston University, the goal is to showcase the reality, amplify the voices of medical women, and organise events with the aim of a local intervention for influential factors at early stages of medics’ careers. We are all in this journey together, we learn from each other and we should openly talk about our journeys as they are all different. This helps to strengthen and develop each other along the process. Perseverance is definitely one of the most important aspects in Medicine.

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CAREER PLANNING: BUILDING A NETWORK

From the ground up: building a network Sara Memon is a final year medical student and incoming foundation year doctor studying at University College London. She is the co-founder and chair of PAMSA: an organisation linking doctors and medical students of Pakistani origin. She has a special interest in Ophthalmology and is also the co-founder of Ophtnotes, a new venture with the aim of making ophthalmology accessible to undergraduate students.

The creation of PAMSA I started PAMSA, the Pakistani Association of Medical Students and Academics, with two colleagues back in 2019. We’ve since expanded from a handful of keen students to around 800 members, running multiple operations from health promotion to CV building opportunities.

12 Medical Woman | Spring/Summer 2022

Why PAMSA? It might seem a little niche at first glance. Is there really a need for an organisation focusing on medics from a specific community? We noted the strong prevalence of our community in the medical field, both British born and International Medical Graduates. Initiatives exist for the latter to facilitate their transition

CAREER PLANNING: BUILDING A NETWORK to the UK, which can be a really challenging process. However, there was nothing quite there for those of us who had gone to school and medical school in the UK, and we weren’t sure why.

With the three of us being British-Pakistani, and between us knowing hundreds more just like us, we knew we make up a sizeable chunk of students and junior doctors.

In the current ultra-competitive climate with speciality training posts relying on ambitious portfolio hoops to jump through, the new mantra is: ‘it’s not what you know, but who you know.’

Whilst this concept is highly problematic and work is needed in the widening participation field to combat inequalities within healthcare, undoubtedly having a strong network and community is essential. Although mentorship from doctors is invaluable to students, it often relies heavily on good-will, and when mentors get busy with their tight work schedules it is this voluntary work that takes the hit. All I was looking for is having as much glue as possible to sediment the mentor-mentee relationship.

Two ways I felt this was possible was a) incentivising it for the mentors and b) creating a community. A community can be created very effectively through shared language, shared culture and shared struggles.

We therefore created a mentorship scheme where a group of 4-5 students with similar interests were matched to a doctor training or working towards the same field. Demand for mentors outweighs the supply, which is why we were initially drawn to group mentorship, but we soon realised this way students are able to meet like-minded individuals. They got insider information about the speciality, tips on CV building, and worked on projects within their groups.

Constantly reshaping We recently appraised our mentorship scheme and had the opportunity to present it at the Aga-Khan University Annual Surgical Conference, using the data to see the impact of this carefully curated mentorship programme on medical student outcomes. This is one of the biggest medical conferences in Pakistan which I was really thrilled about.

At the conference, it was heart-warming to see the team be so proud of our work. Sometimes, unless your success is staring at you in the face, it’s easy to lose track of it. Showing the team how hard they’ve worked in this way every now and then is something I’ve come to realise is invaluable.

Following appraisal and feedback we’re revamping our mentorship scheme, this time pre-planning a set number of sessions over a defined period and incorporating teaching sessions within the mentoring. This way, mentors can benefit from national level teaching for their own applications. It’s a win win.

Is there more to PAMSA? After having built this network of students and doctors of South Asian origin, we realised we’d created a strong force to combat some of the big issues in our community. The main areas we’ve been focusing on are mental health, lifestyle medicine and language. The South Asian community contributes a lot to the workforce of the NHS, and it also makes up a large part of the patient cohort. It is essential for those of us who can understand their language and culture, to understand their problems too.

For example, I was shocked at lifestyle medicine advice advocating

for European recipes devoid of spice, salt or fat. I knew in a heartbeat this would not work for our community, a community that also suffers extensively from diabetes. A healthy lifestyle must be promoted which is in line with our cultural sensibilities.

Alongside our health campaigns we also run a series on our social media focusing on snippets of medical Urdu, enough to take a medical history, ask if in any pain, or do basic procedures.

A female leader When I first started sharing PAMSA with the world through social media, the first thing I thought was, “Will this be perceived as showing off?”, “Am I too much?” “How much is too much?”.

I then thought to myself, would I worry half as much if I were a man?

I feel that to be an effective leader as a woman you need to strike a balance: confident, but not too confident. You must make good points but follow them up with “that’s just my opinion though”.

If you get the balance wrong, you run the risk of being ‘intimidating’ and ‘overbearing’. I’m still navigating this space, and it’s been far from perfect. My leadership skills are a work in progress, but the realisation of this alone will serve me well in the future.

Medical Woman | Spring/Summer 2022 13

FEATURE: EXPEDITION MEDICINE

Type 2 fun: the challenges and opportunities of expedition medicine Samantha Moore is an anaesthetic trainee and expedition medic based in the North West.

Her research interests are in prehabilitation of the high-risk surgical patient and human physiology in extreme environments, including high altitude and microgravity. She holds the UIAA Diploma in Mountain Medicine. Sam is the co-events lead for Trainees with an Interest in Perioperative Medicine (TRIPOM).

If you’ve ever heard the expression “type 2 fun”, you’ll understand the experience of being an expedition medic. It might sound glamorous, jetting off to far-flung destinations, but usually, it comes with a dose of harsh reality.

My first adventure flexing my medical muscles outside of the hospital came with a 3-month expedition to Tanzania with a wellknown youth development charity. Fresh out of the foundation programme, I was keen to experience working and living abroad.

Still, I had much trepidation about being very responsible for a group of young people in the middle of nowhere.

While I’d been lucky enough to travel to some of the remotest parts of the world, I’d usually only had to take care of myself. With a classic bit of imposter syndrome, I worried how my skills would hold up in the face of a traumatic emergency halfway up a mountain.

Thankfully, I was very well supported, and we had very few incidents. What became apparent was the need to get comfortable with uncertainty and expect the unexpected. An odd rash turned out to be a caustic burn from a Nairobi fly (strangely not covered on the medical curriculum) and led to a publication in the Journal of Wilderness and Environmental Medicine.

While I mostly spent my days treating blisters and minor ailments, there were a few times where I felt my heart rate rising. From scorpion stings to appendicitis, finding snakes in unexpected places and teaching young people how not to set themselves on fire while cooking using meths, there was always something happening.

One of the most important things I’ve learned is the need to be comfortable in whatever environment you’re working in. If you’ve never been to altitude, put a hammock up in a jungle, or worked with groups of teenagers, there might be some additional challenges! If looking after yourself is a struggle, it becomes impossible to have the bandwidth required to make sensible decisions and care for other people.

As doctors, we can be pretty confident in our ability to manage emergencies, but the strategies that work in the hospital are not available when you’re outside. It’s vital to be flexible (and often creative!), work well within a team and communicate clearly. Luckily real emergencies are few and far between. Still, it isn’t just medical knowledge that saves the day but understanding the logistics of evacuation and the local amenities when they occur. You need a plan A, B and C and the flexibility to realise that often it’s going to be plan G that works out!

When I returned to the UK to start my anaesthetic training, I wanted to keep up my expedition skills and formalise them with a qualification. There are many courses, diplomas and even Masters 14 Medical Woman | Spring/Summer 2022

programmes to choose from, but as mountains are my happy place, I chose the Diploma in Mountain Medicine (DiMM).

While I learned so much from my time on the DiMM, meeting other like-minded medics was one of the most critical aspects. For the first time I learned about portfolio careers, I learned from people who had managed to mix formal medical training and expedition work.

I’m lucky to have an incredibly supportive school of anaesthesia, which hasn’t always been my experience. When I first took time out of training to go on expeditions, my supervisor advised me strongly against it, claiming I wouldn’t have a job to come back to. But working in remote environments has given me confidence, taught me new skills and topped up my levels of joy. All of this comes back to the hospital with me and hopefully makes me a better anaesthetist.

Over the years, I’ve made improvised spacers for inhalers out of water bottles, treated high altitude cerebral oedema (HACE) in Alpine huts and talked a non-medical group through managing an anaphylactic reaction over a dodgy sat phone connection. What I wasn’t expecting, maybe naively, was the prevalence of mental illhealth amongst expeditioners. Often this is longstanding and well managed at home, but usual management strategies sometimes fall down when pushed out of comfort zones. As an anaesthetist, I felt that my mental health training was somewhat lacking, and this has become an area of keen focus for my professional development. I started with a mental health first aid course and have learned more about teams’ fascinating psychology in extreme environments.

The world of expedition medicine is vast, with opportunities to work on TV shows, commercial expeditions and scientific projects.

For me, the most incredible job satisfaction comes from youth expeditions. Working with young people in wild places I’ve seen the genuinely transformational ability of expeditions, especially for those who wouldn’t usually have access to such experiences. Each trip brings new challenges, environments and opportunities, and I wouldn’t have it any other way!

FEATURE: EXPEDITION MEDICINE

Medical Woman | Spring/Summer 2022 15

FEATURE: GLOBAL HEALTH

Investigating motivation and challenges faced by female students on the BSc in Anaesthesia course at Busitema University in Uganda: a qualitative study Nicola Kelly is a doctor who has worked in South London in Anaesthesia and Intensive Care. In August 2021 she moved to Mbale in Eastern Uganda for one year to work in a role teaching on a BSc in Anaesthesia programme at Busitema University Medical school and the Mbale teaching hospital. She has also raised money for anaesthetic equipment to support a hospital in Uganda.

in Anaesthesia at Busitema University, a course which aims to increase training capacity and improve career progression for NPAs in Uganda.

Women currently comprise 36% of students on this programme.

Whilst talking to some of the students I realised that many faced personal challenges to their training – including managing a single parent household between long shifts and exams. Personal conversations with the students also demonstrated to me the huge range of experience many come to the course with – both as healthcare professionals for example, clinical officers or nurses, and as patients. These experiences seemed to have contributed to their motivation to practice anaesthesia. Uganda faces a huge deficit of anaesthesia providers, particularly in rural areas, and I wondered whether finding out more about these motivations and challenges could help guide policy to ensure those interested in pursuing this career were not dissuaded.

This question prompted me to start this pilot project, which aims to share qualitative data on the experience of female trainees on the Anaesthesia BSc course with a view to educating course providers, sharing, and improving the experience of female students.

Results Data was collected from female students on the course via online survey shared via WhatsApp. 14 students responded, with mean age 30.6 years [range 22-49 years].

Background Non-physician anaesthetists (NPAs) are the predominant anaesthesia providers in Uganda, a country with just 72 physician anaesthetists1.

This year I have been working as an educational fellow at Busitema University through a Royal College of Anaesthetists (RCoA) global partnership. My primary role is teaching on the novel BSc 16 Medical Woman | Spring/Summer 2022

Previous healthcare experience 64% reported previous employment, all of which was in a healthcare setting. Some had been asked to administer anaesthesia whilst in these other roles, one reported “working in theatre as a nurse in a district hospital pushed me to do quack anaesthesia just to save life. I want to have true, safe skills in anaesthesia as a trained provider, to help many women during delivery, and others too”.

43% had experience of anaesthesia as a patient, two thirds of this experience was for childbirth. Half of those who had received an anaesthetic as a patient felt that this had impacted their decision to pursue a career in anaesthesia. Specifically, it was the poor quality of care and lack of trained providers that lead them to train; they

FEATURE: GLOBAL HEALTH said “there are very few qualified anaesthesia providers in my country and I survived by chance. Like many rural women” and “I saw women suffering due to child related complications because of delays due to shortage of human resource”.

Motivation for training The most reported motivation for training amongst the group was the lack of anaesthesia providers in Uganda and a desire to treat pain and improve safety, particularly for pregnant women. One respondent said, ‘due to their limited number some procedures which would be handled in certain health care units are referred causing delays, delays which lead to death especially maternal death’. Others were driven by career goals such as improving their CV and their passion for anaesthesia, love for the course and the ‘freedom in decision making’ the career would afford them.

Challenges and barriers Most respondents felt that there were gender specific challenges and barriers to the study and practice of anaesthesia in Uganda.

Two respondents reported that there was a belief that the BSc in Anaesthesia course was not ‘suitable’ for women. They said, ‘there is a belief that the course is for men because it is one of the tuff (sic) courses so most ladies shy away’ and ‘it’s said that this course is suitable for men and not good for women because of risks of abortions’. The second comment relates to the lack of waste volatile scavenging in theatres. Exposure to volatile anaesthetics is a known risk factor for miscarriage amongst anaesthetic providers which is clearly a concern for women on this course as the comment came up numerous times within our survey.

Other respondents commented on the stress of balancing the job with marriage or children, ‘the fact that they are still few in my country puts a big workload on those in the field, with people developing a mindset that you can’t have a stable marriage and a career due to the abrupt calls to hospital that come with it, with people joking that you choose between marriage and a career.’

64% of respondents were mothers despite the concern that ‘the fact that you need to invest a lot of time hinders some women especially those with children from joining the course’. All but one had taken some maternity leave after the birth of their children (duration ranging 45 – 90 days). Those that had children seemed to find the earlier months/years of motherhood most challenging, particularly due to the difficulty breastfeeding whilst working, ‘according to my experience before I was given maternity leave it was hectic and stressing because there is no time for breastfeeding the baby during working hours’. There was also concern amongst the mothers about the need and quality of childcare available to them whilst they were at work, ‘in our culture the care of a baby is basically a mother who takes full care. The work place needs a 100% of your participation. If a family member is involved [in childcare] it can be for a short while. Partner is there but is taken up for his job elsewhere. The only way is to hire someone who in most cases ends up mistreating a baby.’ Some suggested they would have a preference for working nights to better manage childcare and that women should have protected time during the day to facilitate breastfeeding mothers to return to work.

Half of our respondents felt that gender discrimination was a problem in healthcare saying ‘because there is a belief that female gender is weak so there is a preference for males than females’ and ‘some organisations don’t want female workers because

they’re always getting pregnant and getting maternity leave’.

It was also interesting to hear comments about how high living costs disproportionately affect women ‘cost of living in a certain area becomes very hard, which is a risk to a girl child’. The respondent did not elaborate on this, but we hope that in future work we will be able to explore this area further.

Conclusions Lack of access to safe anaesthesia in Uganda disproportionately affects women of childbearing age, as caesarean section is the most common surgical procedure performed in the country2.

Women training as NPAs in Uganda face significant challenges, particularly when balancing their career with motherhood. Some challenges are not unique, with female anaesthetists across the globe managing similar decisions and compromises3. Developing flexible approaches that allow women to train, and ultimately work, around their other commitments is vital to ensure these experienced and motivated individuals are not dissuaded, in a setting desperately in need of their skills. Having completed this pilot study we are now undertaking a larger piece of work to investigate this topic in more detail and I look forward to sharing our results with the MWF in future.

References 1

Word Federation of Societies of Anaesthesiologists (WFSA) website.

Available at: https://wfsahq.org/member-focus/member-societies/uganda/

2 Albutt,

K., Punchak, M., Kayima, P. et al. Operative volume and surgical case distribution in Uganda’s public sector: a stratified randomized evaluation of nationwide surgical capacity. BMC Health Serv Res 2019;19:104.

3 Bosco

L, Lorello GR, Flexman AM, Hastie MJ. Women in anaesthesia: a scoping review. Br J Anaesth. 2020;124(3): e134-e147.

Medical Woman | Spring/Summer 2022 17

SPOTLIGHT: WAVES OF INTEREST

Waves of interest: working towards consistency Scarlett McNally is an Orthopaedic surgeon in Eastbourne, and President-Elect of the MWF. She is deputy director of the Centre for Perioperative Care, has a MA in Clinical Education and MBA. She was a Council member of the Royal College of Surgeons of England (2011-21). She is lead author of ‘Exercise: the miracle cure’ and a report on What we should call Junior Doctors (due 2022).

Scarlett has four children, three electric-cycles and a stem cell transplant.

State of play I am truly delighted to have been elected to President-Elect of the Medical Women’s Federation. My background is as a Consultant Orthopaedic Surgeon but I have also worked on initiatives to encourage the population to do more exercise to improve health.

Both increasing equity and increasing exercise require a multipronged approach. Action needs to occur at individual, cultural and institutional level. There are multiple audiences. Data and personal testimony can be helpful in prompting change.

Over the last 30 years, I have seen waves of interest in feminism.

Sometimes I fear I have been part of the problem, normalising the status quo. I collated data analysing applicants to surgical training showing that women who did apply to surgical training were statistically significantly more likely to be appointed1. This allowed the institutions to relax – not taking responsibility for those women who failed to apply for higher surgical training (only 16% applicants were female in 2009) despite having completed core surgical training (with 30% female applicants).

As a Council member of the Royal College of Surgeons of England (2011-2021), I focused on actual hurdles, providing information and practicalities. This included clarifying the undergraduate curriculum in surgery, writing guidance, giving advice on learning in the operating theatre, job planning, revalidation, working with x-rays or during pregnancy and breastfeeding. We created guidance and e-learning encouraging senior surgeons to identify their unconscious biases with explicit instruction to ‘fake it till you make it’ and say what they would say to another in that role, to be supportive. Most of my offerings from that era are on www.rcseng. ac.uk/study.

It could be argued that the best thing I did for surgery was not getting elected President or Vice-President. On my final attempt, the four successful senior officers being older white males triggered the Kennedy review into diversity across surgery and at the College.

Feminism has lurched between encouraging women to ‘have it all’ and discussions about whether a sticky floor or glass ceiling prevented progress. Ten years ago, Sheryl Sandberg exhorted women to ‘lean in’, to fit the part. That might be useful advice for one woman trying to fit into a man’s world, but it misses the fundamental need to change the work environment so that the default full-time male is not the default. Every person should be permitted to be their authentic self at work. The expectations of each role should be clear, and the same for each post-holder. It is possible that the biggest issue amongst our senior colleagues is a 18 Medical Woman | Autumn/Winter2021

SPOTLIGHT: WAVES OF INTEREST misplaced view of perfectionism. To achieve behavioural change, we need to understand the mindset of those inadvertently blocking it. It is the highly competitive specialties that have felt no need to change2. For these, data are useful in supporting leaders to accept that perfectionism and meritocracy is an illusion. 10-15% of operations result in complications; complaints and claims are increasing; ‘never events’ have plateaued and burnout affects up to 50% of doctors over the age of 50. Once leaders accept that no-one is perfect every day, there is scope to consider a minimum standard as well as an aspirational standard. This minimum standard allows for personal growth with patient safety. It should allow respect for every person for the hours that they are there.

For women, there are three phases where progress is worse.

Firstly, support and development in their career-defining role where they ought to be respected and offered opportunities.

Secondly, differences in practicalities around pregnancy and childrearing – “the motherhood penalty”. Thirdly, lack of support or encouragement within or into senior roles. We should acknowledge the unconscious biases that everyone holds. All senior roles should be advertised, with fixed length of tenure and clear application process with defined skills, such as how to chair a meeting. Even in areas where equality legislation is relevant, such as pregnancy, employees may be unaware or reluctant to challenge. In general, people do not realise they need a network or trade union until they are suddenly confronted with a need.

“To achieve behavioural change, we need to understand the mindset of those inadvertently blocking it.”

As a network of women, we can fight about issues that commonly affect women in general in a gendered way, and also fight for any individual woman’s right not be defined by a stereotypical view on how to live her life. A network can be highly supportive for those within it and allow cross-generational perspective, advice and sounding-boards.

There is increasing evidence of different experiences that women have daily, such as being mistaken for someone in another role, and of different expectations that people have of women and men. Women are more likely than men to delay having children3 or leave training posts because of multiple irritations like a tumbling ‘tower of blocks’4. The Kennedy review documents the ‘microaggressions’ that women and other minority groups are exposed to5. The gender pay gap6 perpetuates difference – in a male-female partnership, if the woman earns less, it is she who is more likely to reduce their hours to deliver more childcare. MWF has demanded shared parental leave for both parents, irrespective of gender.

This should be ‘use it or lose it’ for the father or second parent to stimulate a change in social norms.

Data can be very helpful in shifting opinion on the need for action.

For example, exercise works as primary prevention and part of management for many conditions. At the minimum level of 150 minutes per week, moderate exercise can reduce a person’s risk of getting dementia, depression and bowel cancer by 30%7.

Yet one-third of adults do not achieve this minimum level, with women far less likely to be active. This scale of potential health improvements creates a huge impetus to improve opportunities

“Data can be very helpful in shifting opinion on the need for action.” for people to be active. I have highlighted that increased physical activity would reduce the need for social care8 and hope that the implied financial imperative makes governments and organisations keen to commit resources.

Evidence of different experiences for women doctors is increasing, with some harrowing. Surely there is now enough for our co-workers to become allies, calling out difference when it is seen, and for institutions to make changes to improve women doctors’ working lives?

Perhaps more data on better outcomes for patients and better workforce retention would stimulate structural changes to improve working conditions?

What of the future?

I should be setting out my manifesto, but my Presidential term only starts in 2024. I am grateful for the long lead-in time, mainly because I can tidy up loose ends. I am just emerging from political restraint – no longer having to run things past College official channels. I have a report on what we should call Junior doctors ready to publish. The answer is ‘doctors’ – people should be valued for what they have achieved, not denigrated for their academic potential. I intend to observe Professor Chloe Orkin’s Presidency and spend time listening to all of you, our members, and to others in positions of influence on health. Then we can plan together how we can be most effective – and still keep the network of support that MWF provides.

“...we can plan together how we can be most effective.”

References 1

McNally SA. Surgical training: still highly competitive but still very male.

Ann R Coll Surg Engl (Suppl) 2012; 94: 53–55. http://publishing.rcseng.ac.uk/doi/pdf/10.1308/147363512X13189526438675 OR: https://doi.org/10.1308/147363512X13189526438675

2 McNally

SA. Competition ratios for different specialties and the effect of gender and immigration status’ J Roy Soc Med 2008; 101:489-492. https://journals.sagepub.com/doi/10.1258/jrsm.2008.070284

3 Goldacre

MJ, Davidson JM, Lambert TW. Doctors’ age at domestic partnership and parenthood: cohort studies. J R Soc Med. 2012 Sep; 105 (9) :390-9. https://doi:10.1258/jrsm.2012.120016 OR: https://pubmed.ncbi.nlm.nih.gov/22977049/

4 Liang

R, Dornan T, Nestel D. Why do women leave surgical training?

A qualitative and feminist study. Lancet. 2019; 393: 541-549. https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)32612-6.pdf

5 Kennedy

R. Our Professional Home. An independent review on diversity and inclusion for the Royal College of Surgeons of England: an exciting call for radical change 2021. https://bit.ly/3uuT2IY

6 Dacre

J, Woodhams C, Atkinson C et al. Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England December 2020. https://bit.ly/3jsUHbr

7 Academy

of Medical Royal Colleges (2015) Exercise the miracle cure and the role of the doctor in promoting it https://www.aomrc.org.uk/reports-guidance/exercise-the-miracle-cure-0215/

9 McNally

S, Nunan D, Dixon A, Maruthappu,M, Butler K, Gray M. Focus on physical activity can help avoid unnecessary social care. BMJ 2017; 359 https://www.bmj.com/content/359/bmj.j4609 OR: www.scarlettmcnally.co.uk

Medical Woman | Spring/Summer 2022 19

CREATIVE ENTRIES

The broken stethoscope, the broken mind, the broken doctor This stethoscope had been with me for 6 years. It had allowed me to listen up to 150 chests and hearts a week.

I feel, it would always be my weapon of choice in the war of disease.

Not CT scans or MRIs like the new generations are being taught. A good old fashioned, stethoscope that tells you the diagnosis by listening and putting things together in the amazing mind we have.

Then 3 years ago, when I was having a bad era in life inside the hospital and outside, not only had my tooth chipped from grinding my teeth from stress, I opened my bag that day to find my stethoscope had snapped in two.

As a heart doctor, my heart sank! I got this when I had graduated and became a doctor.

It was sentimental.

It seemed to represent my mind and body which was also broken at that time.

So, what did I do. Like what we do to our bodies and mind. Cover it up, tape it up and keep going. I used it for 2 months taped up. Doing its job, but I had to keep taping it up every 3 days. It started to irritate me.

Until I realised you need to solve the root cause, I either fix it or replace it.

You either fix your thoughts/bodies or replace your thoughts and body...well you can replace your bad habits that cause your body to be what you don’t want it to be.

So, I replaced it and later I would make it a task to fix my broken one.

I was the broken doctor, with the broken stethoscope.

Enough was enough.

I replaced my thoughts with better ones. I worked hard on my health and I replaced my stethoscope. But I still kept this one, as I knew one day, I would fix it too. We can reset ourselves, mend ourselves, but it’s down to us and our choices to do that.

Not only did this photo capture my trauma but an artist contacted me when she saw my photo and depicted it beautifully in a painting as she was doing a series on ‘Touched’ depicting people’s loss and meaning of items to them.

Grateful to Helen Stone for expressing my emotions and words in her artwork.

Dr Sarandeep K Maarwaha - Junior Doctor prize entry 2020

20 Medical Woman | Spring/Summer 2022

CREATIVE ENTRIES

Conversations Across the Table So, you want to do surgery, that’s great, good for you.

The world is your oyster, you can do anything you choose to do With that confidence in your heart and the fire in your eyes.

Have you sought some advice from those already on the rise?

What are your aspirations, which specialities have you thought through?

I’m doing ENT, so my fiancé can have a career in ortho too.

I picked something supportive for when I want to have a baby, Urology’s a good choice, so you can be there when he can’t be.

Maybe not orthopaedics, you didn’t do rugby, right?

Oh, you went to a private school, then you’ll be alright.

Are you as strong as an ox and as smart as one too?

For this boy’s club you’ll need to do more than just hammer and screw.

How about General, they seem all-inclusive?

If you want to wield a knife, they’re not racially exclusive.

Post-covid they’re not too concerned with trying to save the old, The waitlists are too long to fix them all, so I’ve been told You’re considering Plastics, that would be fun to pursue, Head to Liverpool for aesthetics, there’s plenty to do.

There’s great money in private work, you can name your terms, Oh, you want the skills to take home, to debride women with chemical burns?

Don’t complain about the heat in theatre until you reach my age, Try having a hot flush in these gowns and keeping your mind engaged!

Boss, do you think we’ll run late? Oh no I’m happy to stay, The sitter will put my baby to bed whilst we beaver away.

Don’t worry about the NHS, Sewell said we were fine, We have pregnant women who can operate, see here’s one in a picture online.

Homophobia is fixed with a rainbow badge so people can’t make jokes about being queer.

Consultants got a pay rise and politicians branded the rest heroes at the Thursday cheer.

This is the new normal now, I’m sure you will notice the difference.

Being an F2 in a pandemic you must have learnt some resilience?

It was great how you paused your portfolio to help us fight off the virus, But now that we’re past that, you’ll need to do more than ever to inspire us.

Dr Emma Wauchope - Winner of the Junior Doctor prize 2021 - prose

Medical Woman | Spring/Summer 2022 21

CREATIVE ENTRIES

Trivial Pursuit You gather your pieces As you walk towards the boardroom The books, the lectures, the prize-winning papers Are you more than what you consume?

You appraise your fellow players Shined and buffed to perfection Yet no one shares the unspoken question Are we going in the right direction?

You are already whole When you arrive at the board A mother, a lover, a believer, a campaigner Which one can you lose to claim the reward?

You watch your fellow players Discard these segments of self, of wealth Exchange them for wedges of success No time to wonder, is this all worth your health?

You play the game from necessity Your love for the cause Find solidarity in your fellow players Do not lose what is yours.

Dr Clara Radovanovic - Junior Doctor prize 2021 entry

22 Medical Woman | Spring/Summer 2022

CREATIVE ENTRIES

COVID-19 has thrown a stark light on inequalities in healthcare.

What are the challenges that we face and how can we tackle these to move towards a more diverse and inclusive society, that is fit for the future?

The COVID-19 pandemic was a harrowing time for many worldwide, and we are still seeing the devastating effects of the pandemic to this very day. It was this chaotic and catastrophic environment that highlighted the already present health inequalities in society.

One aspect of COVID-19 that was brought to our attention is how the virus seemed to disproportionately affect non-white communities, both in terms of number of deaths as well as the number of hospitalisations(1). A virus that everyone felt was lurking around every corner seemed to take on a more murderous and vindictive energy for many non-white people who didn’t know which family member or friend this silent killer would choose as their next victim.

These racial health inequalities highlighted by the pandemic have multiple roots, to name but a few: Discrepancies in how medical students are taught to treat white vs. non-white patients; the lack of availability of materials (including on the NHS website) that show dermatological manifestations of diseases on darker skin; and medical equipment not providing accurate measurements on darker skin, as research done in the US on pulse oximeters demonstrates(2).

In this essay I will be focusing on the discrepancies in medical school teaching and how we as medical students can tackle them to lesson the burden of racial health inequalities in our future practice.

At medical schools up and down the UK, the teaching, like many things in our society, is centred around the white experience. An example of this is not being shown how hypoxia presents in those with darker skin. If those in healthcare and at home were taught and armed with this knowledge from the outset, it is possible that the mortality rate of COVID-19 in non-white communities may have been different.

So what can we can do at our medical schools to promote antiracism and inclusive teaching?

• F ind out who are in a position of power that can make changes to the curriculum in your medical school This may involve contacting the degree programme director or someone in a similar position. If this proves difficult contacting the office in charge of medical students and asking them who are the best people to get into contact with would be worth a try.

• F ind places in the curriculum where the non-white experience can be added, such as in case studies Often in case-based teaching a vast majority of the patients used are white, and the people of colour that are used in cases play into stereotypes such as immigrants who are unable to speak English. If this is the case in your medical school you can get into contact with the person in charge of organising these cases and discuss making them more diverse and inclusive.

• Organise focus groups Getting together a group of students and discussing where you feel changes can be made is a great way to bounce ideas off of each other and hear from different perspectives that may highlight issues you might not have considered.

• Push for the inclusion of discussions about systemic racism in the curriculum It is vital to acknowledge the mental and physical trauma that systemic oppression causes on non-white bodies. The term ‘weathering’ coined in a study by Arline Geronimus is used to describe the continuous stress of racial trauma experienced by non-white people leading to health deterioration much earlier on in their lives compared to their white counterparts (3). This can be seen in maternal mortality rates where black women have more than five times the risk of dying in pregnancy or up to six weeks postpartum compared to white women(4).

We are not taught about the reasons why there are these discrepancies, such as racial biases in pain perception and inaccuracies in treatment recommendations(5). This means medical students continue to be unaware of their subconscious biases and carry these into the workplace once qualified, therefore allowing these health inequalities to persist.

•A pproach lecturers directly if you see they have not included non-white skin tones in their teaching It may feel daunting to approach a staff member to mention this but there is no need to feel anxious about doing so. As long as you do so politely, many lecturers are open to feedback and constructive criticism, and you would be surprised as to how many lecturers are thankful that you pointed out an often unintentional oversight!

To conclude, the burden of health inequalities may be reduced by inclusive and diverse medical education. We are often told that as medical students we have to wait to become change-makers, to hope that things will change with time or to wait until we become consultants to be able to carry out real change. However, by working together we ourselves can be the change we want to see in healthcare.

References 1 McNally SA. Surgical training: still highly competitive but still very male.

Ann R Coll Surg Engl (Suppl) 2012; 94: 53–55. http://publishing.rcseng.ac.uk/doi/pdf/10.1308/147363512X13189526438675 OR: https://doi.org/10.1308/147363512X13189526438675 2 https://pubs.asahq.org/anesthesiology/article/102/4/715/7364/Effects-of-SkinPigmentation-on-Pulse-Oximeter 3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470581/ 4 https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACEUK%20Maternal%20Report%202019%20-%20WEB%20VERSION.pdf 5

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/

Adaeze Chikwe - Winner of the Katherine Branson Essay Prize 2022

Medical Woman | Spring/Summer 2022 23

CREATIVE ENTRIES

COVID-19 has thrown a stark light on inequalities in healthcare.

What are the challenges that we face and how can we tackle these to move towards a more diverse and inclusive society, that is fit for the future?

The COVID-19 pandemic over the past two years has seen the pre-existing healthcare inequalities embedded in society further widen. Although no individual was untouched by the effects of the pandemic, it is fair to say COVID had a disproportionate impact on many who already experience disadvantage and discrimination within society. Recent events have expedited the need to tackle these deep rooted issues in view of creating both an inclusive healthcare system and society for all.

Socioeconomic Deprivation Evidence from multiple analyses suggests a strong correlation between area based deprivation levels and incidence and mortality from COVID-19. The deprived areas in England had over double the mortality rate due to COVID than the least deprived locations.1 Dissecting this further, reports show a larger proportion of those admitted from May 2021 critically ill with COVID in intensive care units were from the most deprived quintile of areas (32.1%) than the least deprived (11.0%).2 This was a pattern reflected pre-pandemic among those admitted with viral pneumonia thus demonstrating that COVID has not produced new inequalities but has rather caused additional challenges to those already suffering health inequity.

Black, Asian and Ethnic Minority (BAME) Communities Another group disproportionately impacted by COVID-19 are those from BAME backgrounds. Reports published found that the risk of death from COVID is higher in BAME groups and when including age, Black males were 4.2 times more likely and Black females 4.3 times more likely to experience a COVID related death than White ethnicity males and females.3 Those of Bangladeshi and Pakistani, Indian and Mixed ethnicities had a statistically significant raised risk of death involving COVID compared with those of White ethnicity.

Of note, analysts were unable to include occupation, comorbidities nor obesity as factors within these reports which is a shortcoming as these domains are known to be associated with greater risk exposure. Consequently these figures, although by no means insignificant, should be taken in context with their limitations.

Mental Health Over two-thirds of adults in the UK report feeling somewhat or very worried about the effect COVID-19 on their life.4 Groups which previously faced barriers to accessing mental health services are also the ones struggling the most with their mental health during the pandemic. Those who already live with mental health problems alongside physical conditions, older adults, individuals who have experienced trauma or abuse, those living in poverty and from BAME communities are all at higher risk of suffering mentally due to the pandemic.5 Failure to improve access to care will further worsen the inequality these individuals face. For example, services for children were inadequate before the pandemic. In England, the vacancy rate of consultant psychiatrists in child and adolescent mental

health services is almost double that of the national average.6 The predicted 33% rise in demand of mental health services over the next three years is not something the NHS are currently equipped for.7 Conclusion The pandemic has highlighted a whole host of health inequities prevalent in society and this essay has only scratched the surface of three key challenges. To overcome the difficulties faced in deprived areas and by those of BAME background, the government must assess the needs of such vulnerable groups and prioritise the implementation of targeted support programmes to alleviate the impact of the virus. These groups are more likely to experience higher rates of ‘Long-Covid’ and other long-term adverse outcomes which has the potential to increase rates of long-term disability, deepening health inequalities.

Accessible financial support for those in socioeconomically deprived locations are required for both patients and their local health services. Education via schools and public health campaigns is a powerful tool and one of the most important modifiable social determinants of health that will have lifelong impacts on health outcomes, economic wellbeing and overall life expectancy.8 Accessibility and funding for mental health services need to be re-evaluated. With financial investment, public health teams within local authorities are able to develop and coordinate a mental health framework according to local need. Long Term Plan commitments to invest in community mental health capacity should be resumed, so that those with mental health problems can access the help they need locally.5 Poor mental health is strongly associated with worse physical health thus posing a long term, uphill battle in caring for those impacted by the pandemic.

All these measures are only a starting point in tackling the discussed health inequalities in the future, kickstarting the evolution of healthcare into a diverse and inclusive environment.

References 1 Ons.gov.uk. 2020. Deaths involving COVID-19 by local area and socioeconomic deprivation - Office for National Statistics. [Online] Available at: https://www. ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/ deaths/bulletins/deathsinvolvingcovid19bylocalareasanddeprivation/ deathsoccurringbetween1marchand31july2020 [Accessed 2 March 2022].

2 https://pubs.asahq.org/anesthesiology/article/102/4/715/7364/Effects-of-SkinPigmentation-on-Pulse-Oximeter 3

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470581/

4 https://www.npeu.ox.ac.uk/downloads/files/mbrrace-uk/reports/MBRRACEUK%20Maternal%20Report%202019%20-%20WEB%20VERSION.pdf 5

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/

6 Rcpsych.ac.uk. 2021. Workforce figures for consultant psychiatrists, specialty doctor psychiatrists and Physician Associates in Mental Health. [Online] Available at: https://www.rcpsych.ac.uk/docs/default-source/improving-care/workforce/ census-2021-completed-draft.pdf?sfvrsn=191319cb_2 [Accessed 2 March 2022].

7 The Strategy Unit. 2020. Mental Health Surge Model. [Online] Available at: https://www.strategyunitwm.nhs.uk/mental-health-surge-model [Accessed 2 March 2022].

8 Fva.org. 2021. Mitigating the impact of Covid-19 on health inequalities. [Online] Available at: https://www.fva.org/downloads/bma-mitigating-the-impact-ofcovid-19-on-health-inequalities-report-march-2021.pdf [Accessed 2 March 2022].

Sylvia Manimaran - Highly commended entry of the Katherine Branson Essay Prize 2022 24 Medical Woman | Spring/Summer 2022

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CREATIVE ENTRIES

The Elephant in the Office: Challenges faced by WOC in the workforce and how to tackle them

The term “girlboss” surfaced in the early 2010s, beginning as a slogan to empower women to achieve their career goals. The meaning later shifted to signify the pursuit of capitalistic gain and has come to emblematise the empty promises of an “equal world”.1 Captured in “girlboss” is the illusion of reclaiming power from a

26 Medical Woman | Spring/Summer 2022

previously male-dominated workforce; this is especially harmful to women of colour (WOC). This rhetoric of white feminism has not served our collective liberation as it has failed to consider the intersectional contexts and politics of gender, race, class and sexuality.2,3 WOC’s intersecting identities mean that they are

CREATIVE ENTRIES

impacted by a multitude of social justice and human rights issues, and it is to no surprise that this translates to the workplace.4 As a WOC studying medicine at one of the least diverse universities in the UK,5 I have grown increasingly exasperated at peers being condescending due to entrenched social bias and dealing with microaggressions almost daily. When such instances occur, my selfdoubt starts to surface and I wonder if there was anything I could have done differently – anything to feel more accepted. I can only imagine what it might be like in the workforce.

One of the major challenges is entry into the workforce. Research shows that WOC are associated with harmful stereotypes that cast them as “unstable”, “overly assertive” and “emotional”.6 These terms are specific to WOC and are not used to describe either white women or men of colour. They perpetuate an implicit bias for selection and since most selection systems are based on likeability, WOC are unfairly disadvantaged by a system built against them. A solution is to provide training to the selection committee, heightening awareness of the current disparity and reducing implicit bias they might portray.7 This has already been implemented in some institutions with favourable results.8 Another salient barrier faced by WOC is workplace ostracism.9 Microaggressions, isolation and incivility are examples of subtle workplace discrimination faced by WOC. Cultural norms play a factor in this challenge. From an early age, girls are taught to “play nice” and this is expressed later in the workforce where women are expected to maintain the role of the non-confrontational caregiver.10 When WOC speak out, they are seen in a bad light.

The experiences vary across minorities of WOC. For example, the “angry Black woman” trope could prevent Black women from expressing their thoughts to avoid conforming to this stereotype and Asian women who are stereotypically submissive are seen as overaggressive when confronting mistreatment.11 Bystander training, which has proven to aid problematic behaviours like sexual harassment, could be used for the mediation of microaggressions.

This would allow for the issue to be confronted without the target being labelled as “overreacting”.12 WOC’s progression in the workplace is hindered by the taking on of service roles. As one study found, African American women at predominantly white institutions spend more time in service roles than their white counterparts.13 In addition, there is cultural taxation where WOC are seen as the point of contact for all things related to their minority group. These all contribute to less time dedicated to their own work.11 It seems like the solution to this is clear, and it is to ask WOC to “Just say no” to these extra tasks.

However, this does not address the matter as a pervasive social phenomenon across society and additionally exposes WOC to criticism for turning down opportunities to educate and reform.

WOC especially are criticised more than their counterparts for saying no to work outside their job description, with stereotypes such as uncooperative and lazy. Instead, the technique should

be switched to “Just don’t ask” to avoid detracting WOC from career progression.11 Although the voice of WOC is crucial to make institutional changes, we should not overburden them with the task of representing all minorities. More specifically, serving as unpaid labour to educate White people who have no intention of creating social change through their own behavioural rehabilitation.

These issues that plague WOC in the workplace should be eradicated by employing interventions that are specific to tackling their unique experiences. It is important to understand that wider systemic inequalities are endemic within the current exploitationcapitalism model, and it is our responsibility as members of society to first understand these power dynamics and then work together to eliminate them. For a world that does not seek to dismantle the systems of oppression that we live under, will only further cement the social inequalities that might be undermined in order to challenge racism and discrimination in the workplace. The reversal of these inequalities is a lengthy battle and I longingly await the day when I will not have to fight to have my voice heard.

References 1 Abad-Santos, Alex (7 June 2021). “Girlboss ended not with a bang, but a meme”.

Vox.com. [Online] [Cited: February 26, 2022.]

2 Crenshaw, Kimberle (July 1991). “Mapping the Margins: Intersectionality, Identity Politics, and Violence against Women of Color”. Stanford Law Review. 43 (6): 1241–1299. CiteSeerX 10.1.1.695.5934. doi:10.2307/1229039. JSTOR 1229039.

3 Zakaria, Rafia. Against White Feminism. s.l. : Hamish Hamilton, 2021.

4 Women’s March Foundation. [Online] [Cited: February 26, 2022.] https://www. womensmarchfoundation.org/about-wmf.

5 Rana, Yas. The Tab . [Online] [Cited: March 1, 2022.] https://thetab.com/uk/ edinburgh/2017/10/13/edinburgh-the-worst-37586.

6 Ashley, W. (2014). The angry Black woman: The impact of pejorative stereotypes on psychotherapy with Black women. Social Work in Public Health, 29, 27–34. https://doi.org/10.1080/19371918.2011.619449.

7 Carnes, M., Devine, P. G., Isaac, C., Manwell, L. B., Ford, C. E., Byars-Winston, A., . . . Sheridan, J. T. (2012). Promoting institutional change through bias literacy.

Journal of Diversity in Higher Education, 5, 63–77. https://doi.org/10.1037/ a0028128.

8 Smith, J. L., Handley, I. M., Zale, A. V., Rushing, S., & Potvin, M. A. (2015). Now hiring! Empirically testing a three-step intervention to increase faculty gender diversity in STEM. Bioscience, 65, 1084–1087. https://doi.org/10.1093/biosci/ biv138.

9 Turner, C. S. V., González, J. C., and Wood, J. L. (2008). Faculty of color in academe: what 20 years of literature tells us. J. Diver. Higher Educ. 1, 139–168.

DOI: 10.1037/a0012837.

10 Friedan, Betty. The Feminine Mystique. New York: Norton, 1963.

11 Liu, S.-N. C., Brown, S. E. V., & Sabat, I. E. (2019). Patching the “leaky pipeline”: Interventions for women of color faculty in STEM academia. Archives of Scientific Psychology, 7(1), 32-39. http://dx.doi.org/10.1037/arc0000062 ABSTRACT. [Online] 12 Michelle C. Haynes-Baratz, Tugba Metinyurt, Yun Ling Li, Joseph Gonzales, Meg A. Bond, (2021), Bystander training for faculty: A promising approach to tackling microaggressions in the academy, Vol. 63. 0732-118X. 13 arley, D.A. (2008), “Maids of academe: African American women faculty at predominately white institutions”, Journal of African American Studies, Vol. 12 No. 1, pp. 19-36.

Kah Yann Cheah - Winner of the Katherine Branson Essay Prize 2022

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CREATIVE ENTRIES

Women are advancing in the workforce, yet unique challenges are faced by various communities. What are the challenges faced by women of colour and how can we tackle these?

Hospital dress policies versus the hijab: the best of both worlds

There is no doubt that women in the healthcare profession are overcoming the gender hierarchy and flourishing in their medical careers, however, not all women are advancing in the workforce at the same pace. From medical students to junior doctors, hijabi healthcare professionals are still facing predicaments regarding adherence to their faith and contradicting hospital uniform policies.

Unfortunately, this is an issue of such significance that a substantial proportion of these women feel like they’re limited in terms of progressing in their future specialities to protect their faith.

Modest dressing is a well-known and established pillar amongst Muslims and is widely acknowledged amongst the general public, however the notion can be quite subjective. The degree to which people cover up can vary and hence there can be diverging views on some of the dress policies enforced by the different trusts.

Hence it is necessary to have universal rules that are accustomed to all staff’s needs, just as healthcare professionals are eager to alter the nature of care to the patients’ needs.

Policies regarding wearing the headscarf in theatres vary from trust to trust, creating inconsistency across the NHS and causing complications due to misunderstandings between individuals.

Larger hospitals with more awareness address wearing headscarves in theatres and provide guidance, whereas others may disallow it completely. A recent cross-sectional survey identified that over half of individuals are experiencing difficulties trying to wear the headscarf in theatres, with an unsettling 36.5% feeling like they were bullied1. This is something that would not be tolerated by other larger communities. The thought of having to go through this while undertaking surgery training or even for surgical placement during medical school inevitably deters these women away, ultimately contributing to the under-representations of women in surgery.

A change in NHS England’s uniform guidance in 2020 meant Muslim women could wear headscarves in theatres, however many are oblivious to this change or are yet to implement it. In addition to this, there can be a lack of communication, causing these women to be self-consciousness whilst in the hospital due to problems they face by other staff members. This can add to the insecurities faced by staff and medical students starting their clinical placement, hindering their learning during specific specialities. It is

a very frightening experience being told they can’t enter theatres unless they take their headscarf off.

The solution to this problem isn’t one that will require material resources or large amounts of effort, the solution is simple; awareness. If individual hospital communities can establish local projects or initiatives to spread information regarding policy changes, collectively there will be widespread awareness, especially in regions where Muslim women are a significant minority. An example is the surgical scarf project, which has already started to empower and educate2. It’s also about fellow healthcare professionals advocating for each other to make these women feel respected, included and more comfortable in the workplace.

This will ultimately create a better and safer environment for patient care.

Educating people on the forementioned change to guidance on hijabs in theatres can also be implemented as part of medical school placement inductions, to create that awareness and encouragement much earlier on. This can be done by including a section on faith and dress code in the theatre induction training which everyone receives. An alternative could be setting up support groups for people of faith with additional dress needs, providing a point of contact for those with queries. These simple changes do require a group effort but if they are put in place, it will go a much longer way that most people anticipate. It will place confidence and strength in these individuals to help them thrive alongside their fellow colleagues, which is the ultimate goal.

If people can come together, and make these changes, Muslim women can definitely have the best of both worlds.

References 1 Malik A, Qureshi H, Abdul-Razakq H, Yaqoob Z, Javaid FZ, Esmail F, Wiley E, Latif A. ‘I decided not to go into surgery due to dress code’: a cross-sectional study within the UK investigating experiences of female Muslim medical health professionals on bare below the elbows (BBE) policy and wearing headscarves (hijabs) in theatre. BMJ Open. 2019 Mar 20;9(3):e019954. doi: 10.1136/ bmjopen-2017-019954. PMID: 30898792; PMCID: PMC6475454.

2 Isle of Wight NHS Trust - Surgical Scarf Project implemented to support Muslim women looking to build a career in surgery</i>. (n.d.). Retrieved March 6, 2022, from https://www.iow.nhs.uk/news/Surgical-Scarf-Project-implemented-tosupport-Muslim-women-looking-to-build-a-career-in-surgery.htm</div>

Felon Mahrous - Highly commended entry of the Katherine Branson Essay Prize 2022

28 Medical Woman | Spring/Summer 2022

CREATIVE ENTRIES

Medical Woman | Spring/Summer 2022 29

UNWIND: DOCTOR CARERS

We’ve been there: the perspective of doctor carers and the need for creativity Dr Raka Maitra is a trainee in Child Adolescent Psychiatry and Child Psychotherapy in Tavistock Scheme in London. She is passionate about supporting the career development of women and she carries out this aspiration through her various roles at the Royal College of Psychiatrists. She was featured in the 25 Women project celebrating the lives of 25 Women Psychiatrists by the Royal College of Psychiatrists in 2021.

Doctor carers is an unfamiliar term. Parent doctor carers is perhaps an unknown term. There are about 250,000 carers working in the NHS. Some are doctors among them.

Doctors who become carers in their personal lives know both sides of the table – and can bring in the necessary and compassionate perspective of a truly patient and family centred care approach.

But it is not easy for doctors who are carers to navigate training or work. It is not easy for they must learn to negotiate their way through rigid policies of work and leave, and training demands that are not always flexible enough to accommodate caring roles.

In a rigid system, creativity sustains some of these doctor carers.

Some of us certainly have creative hobbies, but most of all they have the patience necessary for a creative process, the tenacity for creative negotiations to offer to their colleagues and trainers, the courage to embrace the unfolding of a career trajectory they had not imagined before. The onus is on the carer.

I am a doctor carer. During the many times I stayed in hospital, I self-taught myself digital art and created pictures of my child blurring or erasing the various medical bits, superimposing some of his favourite cartoons in the hope that when he is grown up and looks at these pictures of his childhood he will find fun, joy and happiness. I wrote poetry for him. I find poetry expresses sufficiently without the need for full sentences. Sometimes we put music to the poetry and call them songs. Poetry has remained my most intimate expression to allow myself to be close to difficult experiences and to be able to communicate quietly to those around me.

During the second summer in the pandemic, a group of women doctor carers formed a Women in Medicine Carers Network (WoMedCaN) to own that responsibility of thinking creatively about career trajectory as a collective, that usually falls on a doctor carer in isolation. This group can be found on Twitter @WoMedCaN, and on Facebook (Women in Medicine Carers Network). These doctors create spaces for considered dialogue. Dialogues that raise awareness, generate curiosity and perhaps move some of the decision makers to think differently about their staff and students in healthcare. This group arose as some necessary conversations were yet to be had; some necessary stories were yet to be heard.

Here is a personal story that a doctor carer shared most generously: “….I call myself an ex-consultant. My child has complex needs which were not obvious to others till I had returned to work after maternity leave, (microcephaly, hemiparesis, autism spectrum, 30 Medical Woman | Spring/Summer 2022

language disorder, selective mutism) and lately significant anxiety and emotional based school refusal.

I stopped work some years ago as I needed to provide care both for my child and my parents (both in their 80s, one going for complex high-risk surgery, no other support around). I thought it would just be short term but it’s been four years so far.

I was told I could only be a consultant if my priority was work, and my child could be cared for by others. There was no recognition that it isn’t easy to have carers with specialised skills and that as a mother and a doctor I was perhaps much more helpful to both my child and my patients if I was supported to juggle both roles.”

The above story is not very different from mine, with the difference that I was able to work with consultants who were able to think creatively. Was it a coincidence that each of them also had creative hobbies such as poetry, art or photography? Thinking with them I was able to chart out – albeit a very very long- route back to work and eventually back to training.

I continue to be a carer along with my partner. It is important to recognise that caring responsibilities may not be temporary. Hence it is important to think about training and work arrangements that allow for the predictably unpredictable life of a doctor carer. The option of losing these doctors from the workforce perhaps shows a gaping wound in the capacity of creative thinking. For the NHS to stand up to their Commitment to Carers1, and GMC’s recent strategy to support doctor carers2, the efforts need to start close to home.

References 1

NHS England and NHS Improvement. Commitment to Carers.

Available at: https://www.england.nhs.uk/commitment-to-carers/

1

General Medical Council. Our strategy 2021-2025 (2020).

Available at: https://bit.ly/3LWB5sx

UNWIND: DOCTOR CARERS

A poem for our patients and colleagues We can Stay awake on On calls Stay awake when our loved ones are frail We can Stand strong when it comes to you For we’ve been there, in the dark, and known fear.

You don’t need to tell us Life isn’t a straight sweet road We didn’t wear those rose glasses, when it came to anger and despair.

We’ve carried on for decades We work. We stop. We start again. And again.

We hope you will care. To walk with us. Yet again. by @Maitra_R

Medical Woman | Spring/Summer 2022 31

BOOK REVIEW

My Name is Why

by Lemn Sissay

Sarah Matthews is a mid-50’s GP who works in Coventry. Her practice is urban and provides services to Coventry University students. She is the Coventry LMC secretary and has recently been elected to GPC. She is married to a histopathologist and they have two sons, Tom and Theo.

She has a longstanding interest in medical humanities; particularly in the patient narrative.

When I was at my previous practice, one of my responsibilities was to have the child protection role. Some elements of this were producing reports for multidisciplinary meetings run by social work; or holding in-house meetings with our midwife, health visitor and school nurse.

But our very forward thinking lead in the city also added on some activity around looked after children (who I might previously have called children ‘in care’.) This led me to think about why that group would be attached to this piece of work, and how we ‘see’ these children. Hearing Lemn Sissay talk about his book on the radio, and later reading it, was a route into a deeper level of understanding.

He comes from a place which looks like rejection. Growing up, he knew his mother was unmarried and gave him up for adoption. He was placed with a white family as their first child but they had three subsequent children of their own and then gave him back into care where he spent all of his teenage years in a succession of increasingly repressive children’s homes.

So, was this about being born in 1967? Well, perhaps in part. I think it is difficult to understand now in a time when over 40% of children in England are born to parents who are not married, the level of disapproval this would court at that time. Lemn and I were born only a couple of months apart and I remember my mother telling the story of how she was heading off to catch the bus for an antenatal appointment when she realised that she was not wearing her wedding ring, having left it by the sink. She ran home to put it on, even though this would make her late (and she was never late for anything in her life). The thought of being seen in that clinic without it was just too much to bear.

One route into his personal history for Lemn was to access the social work notes as an adult and to read through the sequence of events which marked his young life. Some things which were completely essential for him to know had been wilfully withheld, even by those, like his later social worker, who were clearly compassionate and trying to do their best to support him. From his reports, it feels as though when this person works at his best, he is actually in opposition to the system around him.

I wondered if, as a boy from a BAME background, he was particularly disadvantaged in the care system and the statistics would seem to bear this out. It meant he was less likely to be adopted or to finish his education and more prone to negative labels. Other groups where there is stigma e.g. children with a disability are also likely to do badly and we know from bringing up our own children that parenting does not finish at 18. But for the state, it does, and young adults are pushed out into the world to sink or swim. Not surprising that for some of them, with this earlier disruption and lack of support it is hard to make a stable or successful life.

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A key element of discovery was that he was not rejected by his mother, indeed she longed to have him back with her and had refused to sign the papers for his adoption before her return to Ethiopia. The ‘system’ takes him away by writing to her and saying that she will be deemed to have abandoned him if she does not reply to their letter within a month.

And this at a time when post between them and her in each direction would take longer than two weeks, but their address is not direct to her but through a mission society.

If you are prepared to read this, you need to know that your emotions will vary widely. I felt outrage at moments such as the above, deep grief for what Lemn sees as the lack of ‘love’ particularly once he leaves his adoptive home, and anger that any child could be treated so badly, particularly once they had been seen as disruptive themselves. His description of the Wood End home is that of a prison, in fact worse as there would seem to be no process, no right of appeal and no clear end to the time that he might be there.

At my new practice, we have made a small shift in notetaking from describing children who miss an appointment as ‘was not brought’ rather than ‘did not attend’. This makes it clear that the onus is on the caregiver not the child and there is no sanction on the child, nor should they be, if they do not attend repeatedly.

I was reflecting that this same attitude needs to be held in primary schools where children may first be marked out as ‘different’ when they fail to bring in homework. Which of us has a child of that age (5-10) who can organise themselves without being sat down with, read with, or working through the homework sheet together? The value of homework in young children is much disputed, but its ability to mark out this group is not.

We do see some families who we might at times describe as ‘chaotic’ but in the balance of things, it needs to be really pretty bad to take the child away from the parents. We must bear in mind that this is not a neutral act, that the care system is demonstrably damaging and we need to balance the protection of the child from the damage that society, when in loco parentis, can cause.

But the book is a memoir and on realising that this person being described is still the same one collating and writing, that he is a creator of poetry and amazingly has been able to share his life story in this way, I felt uplifted. We need to ask ourselves some key questions: Is the system better now? If, in some ways it is not, do we stand beside Lemn in calling for change? And will we show compassion when we see these ‘looked after’ children to support them and provide them with the services that they need?

BOOK REVIEW

Medical Woman | Spring/Summer 2022 33

Much progress has beenwomen made, The voice of medical but much remains to be done! onmore medical issues