There’s a lot of collective soul searching & general hand-wringing as we approach yet another International Women’s Day on 8th March.
The United Nations Secretary General António Guterres told the Commission on the Status of Women on 7th March that “gender equality is 300 years away”.
Meanwhile the headlines in the UK don’t make for edifying reading either. The consultancy firm PwC finds “UK women priced out of work by lack of affordable childcare” https://www.theguardian.com/business/2023/mar/07/uk-women-work-childcare-pwc-budget with gender pay gap in the UK widening more quickly than in other developed countries.
In the area of mental healthcare, various inequalities exist in terms of experience (women disproportionately represented among those judged negatively and diagnosed with emotionally unstable personality disorders and those experiencing serious impacts of domestic abuse for example).
We now have a fifth female President-Elect of RCPsych Dr Lade Smith, one moreover who in her various roles throughout her career, has fiercely advocated for equality in all areas, and understands intersectional nature of inequalities- whether it’s gender and ethnicity or other multitudinal complex areas. RCPsych is moving in the right direction and am hoping will embed some of the positive change that’s begun.
As the first female President (now Immediate Past President) of the British Indian Psychiatric Association (BIPA- the second largest Psychiatrists body in the UK after RCPsych) in its 25 year history, I am proud to have nurtured and mentored several female colleagues and BIPA has now elected its third female President. This is a heartening trend when culturally, women did not always feel able to access career development opportunities in the same way as men. In this journey we have been supported by some incredible male allies. I am sure this diverse and representative leadership will also lead to better outcomes for patients and professionals.
The recent protests in Iran following the death of Masah Amani, the courageous actions of women in Afghanistan following the restrictions on girls’ right to education and other freedoms, and the vigils and protests in the UK following the brutal murder of Sarah Everard show that the collective raising of voices is louder than ever before.
It’s time to move past the rhetoric, from equality to equity or from intention to action. I see equity as the process of bringing equality to life.
As Psychiatrists, we can do our bit too. Let’s make sure that medical students, a majority of whom are those who identify as women, get the right messages about equal opportunities and treatment in letter and in spirit, that we develop strong female leaders from amongst the next generation and celebrate the combination of strength and vulnerability that allows us to be human rather than heroic. Advocating for patients and carers (majority of whom are women) who are marginalised helps all. Let women’s voices be heard loud and strong in all spheres- patients, people and professionals.
As Amrita Pritam the late legendary Punjabi poet has said,
There are many stories which are not in paper. They are written in the bodies and minds of women.
Amrita Pritam
So it’s with a cautious sense of hope that I greet IWD 2023. Sometimes change happens in spite of institutions and authorities, not because of them. Equality for women will arise from the ground up. Let’s all play our part in keeping alive these seedlings of change through a harsh, prolonged winter of inequality.
Over the last few months we had the first ever annual conference and recently the first awards ceremony of APNA (short for Asian Professionals National Alliance) where the organising team put together a vibrant and warm programme to celebrate the momentous occasion. This was a coming together as a formal organization, of professionals from a wide range of health, care & broader related disciplines with an Asian background. APNA and allies marked the occasion in style.
The time of the year in mid-January which coincided with a number of festivals celebrating the harvest in the Indian subcontinent, seemed fitting too.
The evening was a good mixture of the celebratory (the awards acknowledging the hard work of colleagues) and the altruistic (supporting the Pakistani flood relief effort). The varying cadences of English, Hindi, Urdu, Punjabi and Gujarati melded into the dhol (drum) and the songs; with the shimmering sarees and suits providing a counter foil to a sobering after dinner speech.
While musing over the sense of pride I felt in being a part of APNA, I also thought how aptly named it was. Apna is a word in Hindi with a powerful meaning – our, ours, mine depending on context.
The value of APNA manifests itself in so many ways. Our collective strength yet individual identity, our experiences and memories from the UK and all corners of the world, and a resolve to find our collective voice to improve the health and care system in the UK.
But there is an underlying throbbing drumbeat to this vocal medley. The steady growth of APNA, while speaking to the dynamism & vision of its leaders also shows the enduring nature of the search for a sense of belonging.
For at the heart of every member of APNA there is a longing or hope that our identity is valued as it is; with no embellishments or diminutions. That our potential and aspirations are considered equal to everyone else’s. We are all willing to work to make our world into a more equitable and just space but the wish is to become what we want to be and to belong where we live and work.
The great Hindi & Urdu poet and writer Gulzar has said (translated below):
“I put my wishes & desires to bed every night before I sleep but they wake up earlier than me every morning”
As always I find there is a song in a Hindi film to articulate almost any emotion in a situation. From the movie Imtihaan (meaning test) is the lovely Kishore Kumar song which starts thus:
“Ruk jaana nahin tu kahin haarke, kaanto pe chalke milenge saaye bahaar ke”
Lyrics: Majrooh Sultanpuri
which roughly translates into “oh traveller, don’t be defeated and stop, it’s by walking on the thorns that you get to see the beauty of spring” and goes onto say that “you will never be lonely as long as dreams of love are there within you”.
So as APNA continues to grow there will be setbacks & discordant notes. There may be tears in our fabric, or the threads that connect us may fray and need strengthening. But it is for us as APNA to bring together the warp and the weft to weave our uniquely rich, colourful and imperfect tapestry where the blended fabric still manages to keep the distinct character of each texture.
To end here’s a toast to APNA (with a drink of chai or lassi maybe!) and to the journey from apna to apnapan a Hindi word for a special sense of oneness, connection and belonging.
When I was growing up in India as a teenager in 1980s Mumbai (Bombay as it was called then), a ghazal (a form of rhyming love poetry) sung by the noted singer Pankaj Udhas had become famous and was on everyone’s lips. I would hear the song, ‘चिट्ठीआईहै’ (‘Chitthi aayee hai’, translation: a letter has arrived) from the Hindi movie ‘नाम’ (‘Naam’, meaning name) on popular radio channels, on the weekly television programme based on Hindi film songs, at functions and ceremonies. I could not relate to the sentiments expressed in the song at the time- which spoke of the sense of yearning and grief expressed by a father when his son goes abroad to work and leaves a family behind broken by loss and separation.
I could connect however to the emotion expressed in Pankaj Udhas’s soulful voice and the chord it struck in the parents of some of my older friends who had migrated overseas to study or work. At a time when arguably the exodus from India was at its zenith, the quiet weeping and the messy guilt it brought, along with shiny hope, found utterance in songs like the one above. As Shakespeare wrote in Macbeth,
“Give sorrow words; the grief that does not speak knits up the o-er wrought heart and bids it break.”
Many years later, over 25 years in fact after I migrated to the UK, as I sit writing this blog, trying to make sense of the devastation caused by Covid19 and taking refuge in well remembered songs from my youth, the sentiments expressed in the ghazal hit me with full force. Stories whirl slowly like a kaleidoscope in front of my eyes. I remember the sadness in the voices of my indigenous colleagues and friends as they talk of being unable to visit their elderly parents; lonely and afraid in hospitals and care homes, due to pandemic restrictions which are understandable but sometimes unbearable.
I recall the resigned acceptance of fear and loneliness in a newly arrived doctor’s voice, talking of being very ill with Covid-19 at the beginning of the pandemic and not having any food in the house. Alone in the UK with her family in Africa, she eventually remembered a taxi driver from her part of the world who had ferried her to and from work before the pandemic and was able to ask him to deliver food and leave it on her door step for two weeks while she was self-isolating.
Then there was the international medical student who had to remain; anxious and isolated at the flat he was sharing with three other UK students, all of whom were able to return to their families before the first lockdown. Even after the lockdown restrictions were lifted he was terrified of leaving the flat for fear of breaking a rule inadvertently, being stopped by the police and his student visa being rescinded.
A friend of ours recently journeyed to his home country to see his terminally ill father after several attempts to travel through the latest phase of lockdown, with flights being cancelled and then restricted. His father, caught between wanting to see his son and fear for his son’s risk of Covid19 and the stress of quarantine, tried to dissuade him. Our friend travelled, only to hear that his father died while he was quarantining in a hotel after landing. I cannot imagine being bereaved and grieving in that place of soulless isolation.
I remember the sorrow, the part yearning and part acceptance in my father’s voice in India when I told him, following his hospitalisation and fortunate recovery, that I would not be able to travel to see him in February as I had hoped, due to Covid19 raging again in the UK. That there was another lockdown, with international travel once again restricted. That the time required for quarantine meant that I would not be able to actually spend time with my family and neither would I be able to take a period of extended leave from work. I could not let down my employers, my patients and colleagues by taking that much time off or God forbid, falling ill during travel. I can visualise my father straining to hear me, rocking in his chair as he looked out of his sitting room window in Mumbai, where he lives alone since my mother passed away almost 12 years ago. The nervous frisson that passes through me at the memory is similar I am sure, to what millions are feeling right now across the world.
“No one ever told me that grief felt so like fear.” ― C.S. Lewis, A Grief Observed
For those of us who are international medical graduates (IMGs) mostly from the LAMIC (low and middle income countries) diaspora, there is also often a self or externally imposed ‘good immigrant’ narrative. To paraphrase the writer Nikesh Shukla a “constant anxiety we feel as people of colour (read immigrants) to justify our space, to show that we have earned our place at the table, continues to hound us”.
But things can be different. Dr Nitin Shrotri, a Consultant Urologist in the NHS in the UK, wrote a personal piece for the BMA (British Medical Association) https://www.bma.org.uk/news-and-opinion/the-case-for-grandparents-and-indefinite-leave-to-remain where he described his own positive experience and made a case for parents of international NHS workers to be given Indefinite Leave to Remain in the UK. As Dr Shrotri says, “this will go a long way, and make our doctors feel valued and cared for”.
Alongside many individual doctors calling for changes in immigration rules to help retain and send a message of support to NHS workers, a powerful blog in the British Medical Journal (BMJ) https://blogs.bmj.com/bmj/2021/01/15/covid-19-has-added-strain-on-migrant-doctors-unable-to-see-their-families/ by leading members of BAPIO (British Association of Physicians of Indian Origin), APPNE (Association of Pakistani Physicians of Northern Europe) and the BMA also asks the Government to review the unnecessarily stringent rules for the Adult Dependant Relative visa, and highlights the plight that many doctors of international origin are faced with the in the wake of Covid-19. A survey carried out by these organisations with several hundred responses revealed a significant proportion of the doctors experiencing stress, feeling unsupported by their employers for flexible leave and feeling it affected their professionalism and work adversely (nearly 60%).
Pankaj Udhas’ song continues:
देश पराया छोड़ के आजा (Desh paraaya chod ke aaja, translation: leave the alien country and return)
पंछी पिंजरा तोड़ के आजा (Panchi pinjra tod ke aaja, translation: Oh bird, break free of your cage and return)
In a peri- pandemic world, it does not feel too fanciful to talk of having to choose between Scylla and Charybdis.* Where do the boundaries lie for me and others between love and duty to my work as a doctor, to the NHS which is overburdened right now and to the love for my family, in my motherland? The choices we make around migration are largely ours but which can never be undone fully. We can never un-know what it is to be caught in a dualism that gives and takes in equal measure.
“The tears I feel today
I’ll wait to shed tomorrow. (Anne McCaffrey, Dragonsinger)
In the survey referred to above, almost 85% of doctors had considered relocating to their country of origin or another country where they would feel more supported. We need to collect this data regularly in the UK when doctors, including international doctors leave the NHS to work abroad. Grief unshared and unexpressed; when people are oceans apart, trying to bridge a yawning gulf of indifference, inequalities and illness, can swell up to consume us. There is a powerful humane, moral, social and financial case to be made for healthcare workers serving the NHS and care sectors in the UK to be able to have their parents and adult dependants with them.
Amidst this sombre landscape, love wafts through like a breath of fresh air. As has been expressed many times and in the simple but strong words here:
“So it’s true, when all is said and done, grief is the price we pay for love.” ― E.A. Bucchianeri, Brushstrokes of a Gadfly
We cannot bring back our loved ones and we may be far apart from them, but we can cherish and nurture the wellspring of love from which grief gushes forth yet can be channelled too to build a new future. For as Mahatma Gandhi said:
*Being between Scylla and Charybdis is an idiom deriving from Greek mythology, which has been associated with the proverbial advice “to choose the lesser of two evils”.
2020 was a year like none other for most of us in living memory. As millions around the world fell prey to a tiny virus which caused mammoth devastation, the need to sustain and nourish from the ever bountiful bowl of Mother Nature felt as necessary as breathing.
As promised, here is a blog capturing the moods of the twelve months of 2020. We began the year in blissful ignorance of what lay in store, plumbed the depths of despair early in spring, and then cautiously held onto gossamer threads of hope through the summer. As the clouds gathered over the horizon again in the autumn and the year ended, the virus re-emerged with altered vigour too.
Yet the river of human hope flows on, fed by tenacity and kindness. so as we maintain a countdown to hope, do share your thoughts; what kept you going in 2020 and what you take with you into 2021.
A 2020 wheel of life…
January – a spare, unsuspecting beauty in the beginningApril – a grave spring July – and we breathed again the glorious scents of summer October – life begins to wither
February – calmly flows the river into the stormMay – hoping, beseeching August – the last hurrah in the skies November – a lockdown winter
March – the spring blooms raise their cautious headsJune – a rose blooms amidst the gloom September – again, the clouds brooding over on the horizon December – a moonbeam of hope in the dark
I am a doctor who likes to connect through prose, poetry, pictures, music, nature and any other experience that crosses my path. I want to use every attempt to chip away at the inequalities that plague our society. Most importantly, the past year seems to have taught me to use whatever time I may have on this Earth by being my authentic self. After all as the great Bard Shakespeare said:
“This above all: to thine own self be true, And it must follow, as the night the day, Thou canst not then be false to any man.” (Polonius, act 1 scene 3), Hamlet
As I sit here typing my first ever blog, I marvel at how the tick of the clock into 1 minute past midnight seems to have unlocked something within me too – a desire to connect with others and share this nascent hope of a still new year, to appreciate the signs of life and beauty around us even as we mourn those who have returned to the earth after a grim battle with a breath-stealing virus.
So I attempt to bring to you in words and pictures my wheel of emotions which seemed to have turned a full circle as the seasons marched on in 2020. During a year when a virus held the world in its vicious grip, I found myself increasingly turning to the vibrancy and beauty of Mother Nature. Coming soon, I will be sharing with you a picture from each month of 2020 that touched my heart, reached deep and soothed me, calmed me, gave me hope and a strength to carry on.
Here is hoping that you, the reader also finds some meaning and solace in these moments of nature’s magic, that they may warm a heart cold with grief or soothe a tired brow or give some colour to a life that feels to be without meaning.
Do let me know your thoughts, share what kept you going in 2020 and what you take with you into 2021.
Medicmusings 