Dr Ramkisson is a consultant child and adolescent psychiatrist and NICE Fellow at Pennine Care NHS Foundation Trust. 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 Ramkisson's story
The word “impact” comes to mind as I write about my experiences, observations, learning and reflections over time. Impacts that people have had on me, influenced my thinking, and led to what I choose to do personally and professionally.
I was born and raised in South Africa, where I had the support and encouragement of my family to study and to overcome difficulties. My parents believe education is an antidote to many of life’s ailments. The message about always trying was reiterated throughout my childhood. Memories of seeing apartheid decoupled and witnessing the beginnings of a new era in the country's history about equality, tolerance and compassion, through the work of political leaders like Nelson Mandela, stay with me even today as we continue globally to think about inequality and fairness.
As a child I was fortunate to read widely and was aware of the impact that infectious diseases like HIV and tuberculosis had on the population in South Africa. On our school placements, supporting underprivileged children to learn English, I saw the impact more closely. At the young age of 12 years, I wrote to the Centre for Disease Control in Atlanta, Georgia, in the USA, expressing my interest in epidemiology and hope of later working with them. I always noticed the effect of life occurrences and diseases on people individually as well as at a public health level. These are possibly the early seeds of my aspirations to pursue a career in medicine.
Through my travels, I had the opportunity to complete high school and my undergraduate degree in India. Living in India was an experience that led me to being more independent, away from my parents at a tender age, whilst supported under the watchful eye of my siblings. Embracing the culture and the way of life whilst doing my studies was a treat; friendships that still hold the test of time bring a smile to me even now despite the distance. Receiving an aerogram or a letter from a loved one far away has so much meaning. I learnt that thoughtful actions and random acts of kindness can make such a difference. Now in a busy digital world, taking the time to hand-write a letter, make something special, or acknowledge someone not only warms my heart, but also may mean something to another.
Over the years I have come to accept that in life each and every one of us has experienced personal challenge. Often there are several that occur and can happen over a long period of time. Be it financial, social, emotional or physical, these moments in time when we are faced with difficulties can seem overwhelming and daunting. The realisation that life challenges are part of the human experience has been quite comforting in allowing me to reach out for support from loved ones, accept that it is difficult, and start to consider how best to approach difficult times. Opening up to others, in particular my family and close friends, has provided so much strength. Often these social connections have sustained me when I have had to rise above challenges and have allowed me to fulfil my ambitions.
Whilst studying medicine, I noticed there is more to healthcare than diagnosis and powerful medication. One’s psychological state and individual mindset have a huge role to play in outcomes. A key factor is also the particular healthcare system. In India, when on placements in field medicine, I saw that financial limitations and the unavailability of the most basic resources seemed insurmountable for some patients and their families. People were grateful for the smallest thing one could do for them, alongside compassion, such as offering a glass of water and a stool to sit on after standing in the hot sun whilst waiting to be seen.
I became more aware of how engagement with health care can often be further complicated by social, cultural and religious norms. For women in particular, this can be a struggle (for example access to education or the traditions of dowry) and I actively participated in empowerment initiatives, generating awareness or change where possible. I started to learn that there is so much more to medicine and found myself drawn to the psychological aspects, coming to understand more not only about my patients, but also about my own life.
After completing my first post-qualification year and spending time travelling with my parents, broadening my horizons further, I contemplated my choices of postgraduate specialisation and decided to gain further experience in psychiatry. I followed family members and decided to look at career options for training in the UK. The initial days were spent acclimatising to a new system and I was struck by what one can achieve in a system that is free at the point of delivery. To be able to help those before me, regardless of their own financial circumstances, was liberating. I am also so aware of the importance of the teams within which we work and how this can help to be successful in any venture or tackling an obstacle.
I also soon realised whilst in training how complex our NHS is. Fortunately, I was able to secure a place on the North West Medical Leadership Programme, which was integrated with the NHS Graduate Management Training Scheme. That was a springboard which provided me with much learning, and again left me thinking about impact. Exposed to the inner workings of senior healthcare leaders and organisations, I gained many insights into factors such as workforce, quality, cost and much more. Bringing all this back into my clinical practice was key to me feeling able to contribute.
I have since chosen to work as a child and adolescent psychiatrist. A career being able connect to and achieve change for the most vulnerable feels highly rewarding, for example when I can help a traumatised child to work through their difficulties and see a better future. This also allows me to play a key role in shifting the trajectory of a child or young person towards a positive outcome, which is amazing.
At the same time, as an educator, I find great joy in empowering others to able to help patients. My work has led me to take on new roles, including becoming a Training Programme Director, helping junior doctors negotiate the processes of their training and maximise individual potential. Now as a Director of Medical Education, I have a more hands-on role and remit in my organisation in directly shaping and enhancing the educational landscape. Developing the workforce is both valuable and enriching.
Addressing some of the challenges with differential attainment (DA) it has been a privilege to be part of a national GMC-funded pilot project with Health Education England working with educational supervisors in various regions. In addition to this, I have been able to co-facilitate sessions on communication skills for International Medical Graduates (IMGs) in core training in psychiatry in the North West and on the national Royal College of Psychiatrists Medical Training Initiative induction. I have also been part of one of the British Association of Physicians of Indian Origin Bridging the Gap national workshops based on DA in formative assessments. Furthering my passion in this area, the focus of my National Institute of Health and Care Excellence (NICE) Fellowship is on exploring the enablers and barriers of IMGs using NICE guidance in their daily clinical practice. All of this stems from my wish to seek fairness in medical education.
In regard to my academic interests, I have been fortunate to work with esteemed colleagues in global mental health, sharing expertise more widely, including with some countries where I had spent time in my younger days. Being able to give back and learn together through collaboration is so powerful. My experiences working with organisations as a NICE scholar and now a fellow have developed my understanding around how research evidence, clinical practice, quality and excellence in clinical care, whilst being mindful of cost, all come together to be most effective for the communities we serve.
Having a young family, balancing personal factors around the health of loved ones and my own, working less than full time, as well as being away from relatives and friends abroad, are things I work through whilst doing what I love as a psychiatrist, educator, academic and healthcare leader. I feel fortunate every day that I have family, friends, peers and mentors who have actively encouraged and supported me to pursue my dreams and career choices. This fuels my determination and passion in my various roles as a mother, daughter, wife, sibling, friend, carer, patient, doctor and member of society.
The one thing that always stays with me is “impact”. We can see the effect on people and ourselves of all the big and small things that we do. Equally, I believe that as well as our more evident direct impact on others, we also impact many people indirectly through our contributions to systems and processes. Focusing on strengths whilst developing our weaknesses with kindness and compassion can lead to many exciting things. The willingness to try, regardless of the outcome, can never be underestimated. I am so grateful to so many people; thank you!