INTERVIEWS FROM THE FRONTLINE: PUBLIC HEALTH

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Anisa Jafar is a trainee doctor in the North West of England and gives her perspective on the battlefront that is public health. She dwells on the importance of the link between global health and a one to one consultation. 


 

Who are you and what do you do? 

My name is Anisa Jafar and I am a trainee in Emergency medicine in the North West of England. I hold an Honorary Research Fellow post at the HCRI (Humanitarian & Conflict Response Institute) following on from my year spent there during my Academic Clinical Fellowship. With a bit of luck I’ll be pausing my Emergency Medicine training to undertake a PhD at the HCRI this coming September.

Of all your learning/training experiences which stand out for you as being the most valuable in getting you to where you are? 

This is a tricky question to answer because I think every opportunity and experience is one which you can learn from and can act as a building block to the next step in your journey.

I suppose two decisions stand out as having had an influence on what I do now. The first was a decision to do the European Option with my medical studies. This allowed me to become proficient in another language, manage my time well, develop my confidence in challenging and unfamiliar environments and begin learning how medicine functions as a speciality outside of the UK. Having this exposure made me consider more deeply how healthcare is delivered as a system rather than just as a one to one consultation. I ended up exploring this idea further during my medical final year elective in Pakistan and during the Public Health rotation of my Academic Foundation training programme in North East London.

My interest in “elsewhere” remained prominent and so the second decision which has shaped my career path I believe was my Diploma in Tropical Medicine and Hygiene (DTM&H). I met like-minded individuals, prepared myself for some time working in a rural South African hospital and very importantly met one of my current supervisors, Professor Tony Redmond, when he was lecturing there. I discussed with him my developing interests as well as my plans for an Emergency Medicine career and he agreed, if I was successful in getting the Emergency Medicine Academic Clinical Fellowship (ACF) I was applying for at the time, I could spend the research component at the HCRI. I was fortunate to be successful and because I’d set a firm research direction in motion, my ACF supervisor was very supportive of not only my planned work with the HCRI but also of my choice to switch the ACF funded MRes (Master in Research) to an MPH (Masters in Public Health) because it better suited my research interests.

Your work at HCRI and your MPH will have allowed you to interact and work with people from many fields beyond and the traditional boundaries of medicine (such as sociologists, engineers, anthropologists, geographers etc) – which professionals/interactions did you find most interesting as a doctor? 

An even more difficult question!!

Getting the chance to understand how other fields approach the same topic is fascinating, and in some ways it makes me realise how narrow my own field of medicine actually is. The work of historians is very interesting to me chiefly because everything we understand about our society and the world around us is only explained by understanding its historical context and assessing the authenticity of source information. I would go so far as to say that our opinions and thoughts are hollow without a grasp of history: I certainly feel very exposed when discussing anything at all in front of a historian!

On a practical level, I am fascinated by engineers and the sheer scale of influence that their work has on every aspect of life. This is especially prominent when I consider the role of medicine in sudden onset disasters: although medics are important in this situation, their utility pales in comparison with the utility of an engineer who has the skills to manage water provision, shelter, waste disposal, communication etc. If you were to choose any professional to join you stranded on a desert island, I’ve no doubt a multi-skilled engineer would beat a doctor any day of the week.

At the same time, mixing with different disciplines of course makes me appreciate the privilege a physician has in their role dealing with people on such a personal and intimate level. Somehow, being surrounded by non-physicians gives clarity to this notion.

How has your understanding of health and medicine changed since you became involved in Public Health, Global Health and Humanitarianism? 

I certainly question everything much more than I ever used to and more specifically I try to imagine a patient journey rather than a consultation in isolation. This is because I have an eye on things like prevention and health promotion as well as the structure, flow and efficiency of healthcare provision in a social context.

Very importantly, the intention and original plan for the UK National Health Service (NHS) has really taken a prominent place in my mind when I compare it to the healthcare systems in most of the rest of the world. The cold hard reality of the politics of healthcare provision can make me feel quite cynical and frustrated, and can also make any sustained positive change seem impossible at times, so I have to be very careful to focus on the individual patient benefit I can at least provide as a physician in order to remain optimistic!

There has, increasingly been a move for doctors and medical students to think more broadly about health and what it means to practice medicine – how successful do you think this movement has been so far and where would you like it to go in the future? 

Medicine has historically been seen as an art as well as a science and this is something which comes as part of the “craft” of managing individual patients. With strides forward in science, ready access to information online and a real focus on evidence-based medicine I think there has been a movement away from considering medicine as an art. The balance probably needs to be shifted a little so that we can use the science in a way which does not lose sight of the human and social side of being a physician. At the end of the day, a patient is a person and needs to be considered holistically if there is to be any improvement in their health: medication and intervention alone is not usually enough. I suspect that including General Practice in Foundation placements has gone some way toward addressing this balance because in this way, all doctors are able to spend some time visualising patients within a setting where they are closer to being a person, a mother, a son, a teacher, a carer etc rather than simply being a patient. In the future I would like to see some method of getting all medics to have a deeper understanding of the mechanics of the healthcare system they are working within as a whole because this would allow us to be better leaders and managers and would enable us to bring about change more effectively.

Finally, what does the term Global Health mean to you? 

To me, Global Health means considering and understanding individual and population health from all angles embedded within a social and political context.

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