Navigating the River: Reflections of a woman in Global Palliative Care
– Dr Megan Doherty, Geneva, Switzerland
Palliative care offers a fulfilling and meaningful journey to those who choose to work in this field. Despite palliative care being an essential component of health, and a key component of Universal Health Coverage, access to palliative care is one of the largest disparities in global health- 86% of those in need of such services are unable to access this essential care. The most recent World Health Organization (WHO) data also found that adequate pain relief to medicines reached only 1 in 5 people, leaving behind many to suffer with terrible pain, which can be easily relieved by basic pain medications.
To address these inequalities, multilateralism, the process of countries working together towards a common goal, is an essential approach to synergise efforts and narrow this gap of inequality in access to quality palliative care. By promoting the sharing of expertise and best practices, and developing evidence-based technical guidance that countries can use to improve their health system, WHO supports multilateral actions to strengthen palliative care. WHO activities are supported by palliative care leaders, champions, experts and educators who contribute expertise and who create and adapt their countries’ health systems to deliver palliative care.
In recognition of International Day of Women in Multilateralism (25th January), I would like to reflect upon my participation in multilateral action in my journey in palliative care and some of the lessons I have learned.
My journey in palliative care has provided me with an opportunity to wear a wide variety of hats in palliative care – clinical work, medical education, research, and leadership. I have led the development of different types of training programs from short courses to the first sub-specialty training program (MD program) in pediatric palliative medicine in Canada. I have also led clinical teams, educators and trainers, research study teams, and teams that manage large development projects.
Find Your Ikigai
Ikigai is a Japanese concept which refers to the thing that gives you a sense of purpose, a reason for living. It is the overlap of What you love, What you can be paid for, What you are good at, and What the world needs. My personal Ikigai is working towards making palliative care available for everyone who needs it around the world. Understanding my ikigai has helped me to accept and embrace my love of work, and to recognize how my work provides me with fulfillment. It has also helped me to make decisions about my career when I had moments of uncertainty or when considering whether to pursue or accept a new opportunity. Take time to figure out what motivates you, as this will give you fulfillment and also prevent burn-out.
Be an Expert in the Science of Palliative Care
After I completed my subspeciality training in palliative medicine, my first job was clinical work in a tertiary hospital. Here, I focused on developing my skills as a clinician and learning how to work effectively as a member of an interdisciplinary team. This was important as it allowed me to develop strong clinical skills which helped build a strong foundation for me to become a leader in palliative medicine. To this day, I make sure to keep up with the relevant literature and new developments in palliative care. When working in global health, we sometimes do encounter colleagues who are skeptical about the benefits of palliative care; solid clinical knowledge and familiarity with the latest evidence is important for effective palliative care advocacy.
Learn by Teaching, Learn to Teach
There are many opportunities to get involved in teaching in healthcare, and teaching others is one of the best ways to make sure you really understand something yourself. Early in my career, I would spend a lot of time preparing for teaching sessions, reviewing my slides, creating clinical cases for discussion, and rehearsing my presentation. After my teaching session, I would reflect on how it went, asking: What went well? How could I make the session more interactive? Were the slides too effective or detailed?
In palliative care, we recognize being able to skillfully “break bad news”, is not an innate ability, but a skill which can be learned and improved with practice, similarly teaching skills can also be developed and improved with practice. It is worth spending time developing your teaching skills, when people see how well you speak and teach, you’ll be invited to speak at bigger events which could be at a regional, national and or even at an international level. Time invested in improving your teaching and speaking skills will allow you to speak confidently wherever you are.
Work-Life Balance
As a woman in medicine, finding the right work-life balance is one of the most challenging things to navigate. When I first became a mother, I felt pressure from some family members to stop working. I struggled with my family’s and society’s expectations. Gradually I learned to listen to myself; I realized that I love my work, and I could be an excellent physician and a leader in my professional life, while also being a good mother for my children, who are now 5, 8, and 10 years old. When I arrive home at the end of the day, I am excited to see my kids. Instead of trying to combine work and family during the same hours, I have found that if I divide my time for working and for family, I can give my best effort to each at separate times. Figure out the balance of work and personal life which is best for you and your family. Reassess the balance and make adjustments, there will be times when your family may need more of your time, and you can adjust the balance.
Chart Your Own Path, but Follow the River
There have been many times, when I have felt unsure of the next step in my career. I have found it helpful to think of my career path as a boat on a river. Sometimes the river branches into two or three channels and I have to choose to go down only one of the paths, but eventually the channels will come back together and re-form the wider river. I need to accept that there might be more than one “right” path to choose.
As a boat, I must follow the flow of the water. When I experience failure or setbacks, I accept that it may sometimes be beyond my control. I may be trying to push my boat against the riverbank, when instead I have to step back and look for the path that the river is following and follow that.
By 2060, the number of people dying with serious health-related suffering across all age groups is expected to increase by 87%, as the population ages and the burden of noncommunicable diseases grows. Participating in global health activities which support multilateralism can be a part of your palliative care journey. Together we can play a part in ensuring the availability and accessibility of compassionate palliative care.
Disclaimer: The views expressed in this article are solely those of the author, and do not necessarily reflect the views of the author’s employer, institution, or other associated parties.
About the Author:
Dr Megan Doherty recently joined the WHO as a consultant for palliative care. She is a palliative medicine physician, originally from Ottawa, Canada. Throughout her career she has worked in a wide variety of settings globally, developing clinical palliative care services and training programs. While serving on the executive committee of PallCHASE, she worked to establish models of palliative care suitable for humanitarian settings in Asia and Africa. She is passionate about developing tools and guidelines in palliative care which can enhance the quality of care and reduce suffering.