March is the month to celebrate being Irish, the definition of which is ever-expanding. I recently attended a meeting where the plight of non-European, non-training scheme hospital doctors was discussed. Our health system is dependant on colleagues who have been recruited from countries all over the world, and often they have been sold a pup.
From the point of view of a person joining our health service from, say, Pakistan, registration is awkward, there are significant barriers to training opportunities, limited options for career progression and our cultural norms are an unknown. At this meeting it was suggested that transparency could be improved through the creation of a “Guide to life in Ireland” booklet that would be provided at recruitment drives.
It was proposed that it should contain everything from setting up a bank account to enrolling your children in the local GAA team… A ‘Hitchhikers Guide to the Galtees’, if you will.
If they do go ahead with this guide, I hope they enlist the help of non-Irish people to help write it. Sometimes it’s hard to see what you are from the inside. Only when I went to dinner with an East African visitor did I learn where our culinary strengths lie. The setting was opulent, the portions were tastefully meagre and when our starters arrived she, very reasonably, asked: “What is this?”
“Pâté. It’s made from duck liver, but it’s spreadable… like butter.”
“Oh my God! You eat the parts of animals that we would not.”
“Oh no, only in the very posh places.”
“I think the best part of your cuisine is your sandwiches, I really enjoyed one that was made with a breaded chicken breast. It was delicious with lettuce and crusty bread.”
“A chicken fillet roll?”
“Yes, I think that’s what it was called.”
Hopefully there will be a chapter in the new guide entitled “Butter or Mayonnaise?”.
It can only be good news for our country that our profession is becoming more diverse. At present, the majority of doctors are drawn from a privileged demographic that is not representative of Ireland’s social make-up.
There has been a lot of talk about representation on the big screen. In 2018 Scarlett Johansson was cast as a transgender man but pulled out when she faced accusations that her casting took opportunities from members of marginalised communities, namely transgender actors.
How can we make our profession more accessible? Do we need to ringfence more opportunities in medicine for marginalised or minority communities? I would like our patients to feel represented by their doctors. Just as a patient is entitled to have a preference for a “lady-doctor” doing their smear, or the “man-doctor” doing their prostate exam, it would be nice if there was an opportunity to get dietary advice from someone familiar with West African cooking. Or speak to someone who knows what life is like on a halting site. Or to have the option of speaking in your native language about your ailments or mental health without the need for an interpreter. Health is an area where the risk of things being “lost in translation” can be costly.
I’m not saying that you can’t communicate effectively unless you are from the same background as your patient; similarly, no one is saying that Scarlett Johansson would be unable to play a transgender man effectively. Following the outcry about the casting, the film, not-starring-Scarlett Johansson, has yet to be made. Unlike Hollywood, we cannot put everything on hold until we cast the perfect mix of doctors. We all continue to do our best to try bridge these cultural gaps.
Exposure and education help us understand and better care for our patients. Conversely, it’s often impressive how whole-heartedly foreign practitioners put themselves into the Irish mindset. While attending a dental teaching hospital with a toothache I was treated by a student from Canada. She suggested that I floss more. I replied nodding, “I will. Yeah.” She then did a double-take and with a knowing smile said, “Wait… is that the Cork thing where you actually mean ‘no’?!” I told her I was from Wexford – we’re a little more straightforward. All the same I was impressed at her knowledge of regional variations.
Our childminder is now considering postgraduate medicine. She attended an inner-city, DEIS school and is the first person in her family to go to college. For unknown reasons, being a doctor seemed unattainable to her (or perhaps undesirable.) The summer spent in close quarters with us led her to the conclusion that you could be normal and be a doctor. I’m flattered. I think?
If she decides to pursue medicine, I know she would be a great doctor and I think it would open up possibilities for other young people growing up in the inner-city. After all, you can’t be it if you can’t see it.
Cristina Warren is a GP and Aspire fellow for ENT skills in primary care