From inability to leave well alone,
From too much zeal for what is new and contempt for what is old,
From putting knowledge before wisdom, science before art, cleverness before common sense,
From treating patients as cases, and
From making the cure of a disease more grievous than its endurance,
Good Lord, deliver us.
By Sir Robert Hutchison (1871 – 1960)
Healthcare is not monolithic. The converse is veritable. The numerous faces and professions in the field are different and ever-changing, inevitably so, to suit and reflect our dynamic needs, consciousness and social organizations. People land in, experience and depart from it in diverse ways. Why wouldn’t this be? Sir Robert Hutchison, son of a wine merchant, an astute physician, an inspiring teacher, a skilled author, armed with a heart that was easily touched by children in distress from his famous litany and teachings was convinced that the only things we should be are humble, compassionate, intellectually honest and curious about the human life in front of us.
As an impressionable teenager getting into the field, the image painted in my mind at the mention of healthcare was that of a man in a lab coat, a stiff body, reassuring face coupled with a frown to show disapproval and concentration every now and then and a stern nurse with relaxed hair in triage. The image was probably a result of being under the care of such people in my formative years. I was a sickly child with anxious parents. I am also the first born child, sired after the trauma of a miscarriage, born of working class parents with access to private medical insurance. It was not until I joined university for my undergraduate in bachelor of medicine and surgery and stayed enough time to intimately know some of my classmates and lecturers that the aforementioned fact was laid bare before me.
I arrived in my class a wide eyed and restless person just fresh from highschool. An entrance I’d like to attribute to pressure by my father, ceaseless luck; that my parents were able to afford my allowances and school fees and that I ended up entranced by the nature of the human body and prospective peculiar privileges. I had good grades but not enough to find my name in the list of people our government was willing to sponsor for this course. At a certain period in primary school I had wanted to be a doctor because I was topping my class, appointed the science prefect and fascinated by the human heart though my favourite system was the gastrointestinal system. In high school, like the support afforded to me, my drive diminished as my world grew. My interest in healthcare took a back seat. The restlessness was because I had other interests I was passionate about and had no strategy or enough support to know how to balance them. Now, medical education is like a neonate, it sucks up your time with urgent and demanding requests. Something has to give. Which to let go, if to let go, what actions will lead you to a path that explores your full potential and what are your abilities are conundrums that students both alike and unlike me face.
How other people found themselves in my class and in other classes in the college of health sciences is equally important. There is the career switcher, as the one whose courage to start over I admire. The degree accumulator, as the one whose tenacity I want to forever possess. The I-am-never-going-to-use-my-degree, as the one who invokes my skepticism. The parent, as the one whose time management skills are impressive. The one who has always had stellar grades, as the one I stopped being envious about, opened me up to different strategies I could use and unique challenges I face.The one whose parents are doctors, as the one that affirmed me like she too wasn’t a student. The one who had never been to the city, who I took second hand cloth shopping.
The one who was not from a national or well known school, who suffered but overcame imposter syndrome. The one whose home was surrounded by a tea plantation and was always forthcoming about the beauty of their land and coldness of their weather. The one who would be the first doctor in their family, may the gods protect them. All these are not just statements about one person. A student could claim more than one of the above instances as their experience. More than we know, we tend to overestimate the role of our efforts and choices and underestimate the role that luck and circumstances play in the fruition of our lives as we live in this classist society. I could go on and on about different backgrounds and situations surrounding getting to university and experiencing it but what stands out to me is how different identities such as economic class, gender, sexual orientation, geographical position of your home, neurodivergence and race influences one’s ability to get to, stay in and thrive in school.
There are many faces of healthcare work. Some are more recognized than others. Healthcare work is not just being a doctor and a nurse in a clinical setting. There is a need to acknowledge the importance of workers like cleaners in the hospital and community healthcare workers. It is also worth noting that the majority of workers in healthcare who do unrecognized labour are women. They consistently hold an invisible bulwark preventing the shift from health to illness.
Moreover, healthcare is becoming increasingly interdisciplinary due to the growing needs of patients, advances in tech and shift toward holistic patient centered care. This means that multiple specialists with knowledge that intersects with healthcare and fields such as data science, IT, urban planning, research, law, education, social work and policy are required. These are all roles that exist outside clinical work. Students can move towards these fields from healthcare or from these fields to healthcare.
“The patient is the centre of the medical universe around which all our works revolve and towards which all our efforts trend,” J.B. Murphy, 1857–1916, Professor of Surgery, Northwestern University.
The practice of medicine is benchmarked against patient journeys. Furthermore, our experiences as patients or watching a loved one navigate being a patient in our healthcare systems contributes to the diversified ideas we might have as students and the different trajectories of our careers. It is my hope and prayer that systemic inequalities we have witnessed and experienced motivate us to agitate for changes that are not mere reforms. These are also opportunities for self criticism on any biases we might hold as a people who are products of a deeply harmful society, harm being the antithesis of healthcare.
As for departures and redirections, I find all choices of other forms of service work such as teaching and advocacy, sciences and simply stepping away legitimate. There are many systemic reasons why someone would choose to step away, some of which may be a different opportunity which provides more fulfillment and is more sustainable or compatible with a person’s lifestyle, burn out, disillusionment, moral injury and lack of appropriate support. These stem from institutions that provide our education and colleagues who are poor team players as well as personal misalignment. It is mandatory to frequently reevaluate and be aware of marketable dominant narratives of contribution and success in healthcare.
Looking back, my understanding of health, the body, care and work has evolved over the years. Borrowing from both African feminism, a school of thought that governs the way I make sense of my world and my undergraduate education, health is not a mere state of lack of disease. Health is the experience of joy, pleasure, love, resilience and justice. Health is deeply relational and political. As persons in the global south, access to knowledge of our own bodies and ability to make autonomous decisions about our own bodies increases power over our own bodies and life hence contributing to the process of self determination of our people. The beauty and connection of the diverse paths towards and from healthcare work is in the commitment to care.
Finally, to quote Lord Lister that it is our proud office to tend the fleshy tabernacle of the immortal spirit, and our path, if rightly followed, will be guided by unfettered truth and love unfeigned. May your path be guided by unfettered truth and love unfeigned in every way you choose to care for our people’s health and bodies.
