Dr Raji is a consultant psychiatrist in intellectual disability and Associate Clinical Director of the Neurodevelopmental Disorders Service at South West London and St George's Mental Health Trust and Associate. She is one of 25 women to be highlighted as part of a special project that celebrates the stories of 25 amazing women psychiatrists.
Dr Raji's story
I started my career in psychiatry in 1991 at the University College Hospital in Ibadan, Nigeria. I was very clear as to my career aspirations from when I did my psychiatry rotation in the 4th year of medical school... I fell in love with psychiatry even though it wasn’t the done thing at that time. It was such a taboo subject that my mother said that they wouldn’t mention my area of specialisation at my wedding.
To me, psychiatry was the most ‘whole person’ branch of medicine I had encountered throughout medical school, and the social aspect made it all the more attractive. As my postgraduate study progressed, clinically, I discovered that mental illness was not the incurable social stigma that I had been led to believe it to be, albeit that there were very limited treatment modalities available. I saw the opportunity to come alongside the stigmatised and marginalised and help people to see that there is hope after mental illness. I passed the Primaries of the three-part National and West African Postgraduate Medical Colleges examinations in November 1991 and Part I in May 1993 with a Best Student Award in the Nigerian postgraduate examination.
I was fascinated by Freud and his theories, even though they seemed so far-fetched to me. I pondered what lay behind theories like those of Melanie Klein, John Bowlby, and others. These were not ways of understanding people that were open to me at the time, and I thought that studying where they left their legacies would open up these avenues of understanding to me and make me a better psychiatrist. I started to understand psychiatry in a transcultural context. I was on course to take the final specialisation exams at the end of 1994 when I was accepted onto the Overseas Doctors’ Training Scheme in psychiatry. So, with great enthusiasm, I embarked on my journey to study ‘Western psychiatry’ properly, under the auspices of none other than the Royal College of Psychiatrists in the UK.
I arrived on a very cold February morning in 1994, with no family in the UK, and I was pregnant with my first child. I was met at the airport by possibly the kindest clinical tutor around! I then faced a challenging few weeks of registrations (GMC, GP, antenatal clinic, occupational health) and Trust inductions and this delayed the start of my training. Being at the start of my 3rd trimester, I couldn’t stay any longer in the hospital accommodation, and I had to find suitable housing and childcare. My first consultant supervisor was a godsend who cared very much about me as a person. Sadly, that remained an isolated experience for a few years. At best, I was met with passive disdain and at worst active discouragement and even insult.
Getting the Membership of the RCPsych1 was not as straightforward as I had anticipated, due to the impact of migration and other life events. I took both parts of the MRCPsych exams more than once, and was coming to the end of my permit-free visa period when another godsend clinical tutor expressed his confidence in my academic and clinical abilities; I was granted a six-month extension of my permit-free visa, during which time I obtained the MRCPsych. This elongated training meant that I had experienced all the psychiatry subspecialties that I was interested in during my basic training, however, none was ‘it’ for me. My last training post was in Learning Disabilities. Within one week, I knew that I had found what I wanted to spend the rest of my career in psychiatry doing.
I fell in love with the holistic, systemic, multi-agency style of working that took account of the whole biopsychosocial approach to understanding the person, their presentation and the setting within which it was occurring. It also started to crystallise those psychological theories that had fascinated me. I started higher training in Psychiatry of Intellectual Disabilities in 1998, and no two encounters have been the same since. This has kept me fresh as a doctor and as a psychiatrist. Working with many systems has helped to develop my knowledge of how best to harness them for the benefit of our patients..
In higher training, I started off in academic psychiatry. However, the demands of long hours preparing lectures and trying to do research was not family friendly, so I had to give it up. I became a consultant psychiatrist in 2002 and transferred my interest in developing people to developing services. I found opportunities for leadership and management.
In 2004, I was encouraged by senior colleagues who believed in me, to apply for the role of a Faculty Regional Representative in Psychiatry of Intellectual Disability. I didn’t think myself capable of taking part in central College processes. I saw myself as a ‘lowly International Medical Graduate’ with a lot to learn and not much to contribute yet. I didn’t think that people like me belonged in such high places. However, my curiosity about how things work, and my interest in systems and processes stood me in good stead.
I didn’t find a lot of encouragement or people to answer my questions along the way. I often felt like the odd one out in places, as I often didn’t know the etiquette of new positions. I find it hard to venture into things without ‘knowing the rules’ and it was quite difficult to understand that there were not always rules, and that some things were developing according to the prevailing ideas of the time. I didn’t always feel welcome as my questions often met with deafening silence and I wished the ground would open up and swallow me in many meetings. You might then ask, why did I persevere? Because I don’t know how to give up.
In 2007, I became the London Division Deputy Regional Advisor and in 2008, the Regional Advisor. The more I was successful, the more my confidence grew. In 2010, I became the first female overseas graduate Chair of the London Division of the College, and the first Overseas Doctors’ Training Scheme member of Council. I continue to struggle with people not taking the time to ask me how to use my name, and they end up using it incorrectly, or not at all. My diffident posture, a legacy of my cultural background, belies my capability and I have found that to many, I don’t look the part. Never has anyone met me for the first time and thought that I am the person they expect to see!
International Medical Graduates are overrepresented among SASG (Specialty and Associated Specialty Grade) doctors2, partly due to difficulties with College examinations. Recalling my experience and knowing the impact of not feeling valued, I sought to understand the work roles of SAS Group Doctors as Deputy Regional Advisor. When I became Chair of Division, I set up training events and meetings for SASG Doctors to facilitate Continuing Professional Development and CESR3 applications. I led in developing a Mock CASC4 training technique focusing on what I know to be the problematic styles of performance for International Medical Graduates who fail the College examinations. This style has become widely adopted. I have continued to develop people as a Clinical and Educational Supervisor and mentor, with excellent all-round feedback. Many of my former trainees have now become valued consultant colleagues with whom I still have very warm relationships.
Outside of work, my faith and Biblical stories of perseverance, coupled with the encouragement of my Church Ministers have kept me going. I found another use for my passion in developing people and services by bridging the gap between age-old Christian and cultural beliefs about mental illness by raising awareness, teaching and providing supervision to Christian health and care professionals supporting Church members in their daily lives. I jointly set up a voluntary organization in South London on the back of this.
I have always maintained clear boundaries between work and home life. My travel from work to home was my transition period of leaving work behind and switching into the mindset of the joys and challenges of family life. It was like taking off the cloak of work and donning the cape of motherhood. Whenever life demanded it of me, I didn’t take on extra work roles, so I had time to focus on the needs of my children and myself. I am very reflective and self-aware. Being a psychiatrist has stood me in very good stead. I practise what I preach. Once I find myself out of kilter, my training and experience as a psychiatrist cause me to ask, what is happening, why now, why in this way? I then find ways of fixing it, which sometimes is just a sense of acceptance.
- Membership examinations are required to progress from the early to higher years of training.
- Experienced doctors who work in roles other than the consultant grade.
- Certificate of Eligibility for Specialist Registration; this is a process by which an experienced doctor is approved to work as a consultant if they have followed a different route than the more common route of a series of training posts.
- Clinical Assessment of Skills and Competencies – this is the final one in the series of psychiatry specialisation exams.