South Asian History Month: My journey from South Asian to UK practice, second motherhood, community and cultural differences
24 July, 2023
This blog post is part of our 2023 South Asian History Month celebrations.
It humbles me to share my journey with my colleagues through this platform. I am of South Asian, recruited as an overseas doctor in UK exactly four years ago, just before the Covid became an inseparable reality for all of us. And, I’ m also a proud mum to two beautiful daughters, aged eight years and 18 months.
I must say my journey is in no way unique or exceptional, it probably is very similar to the journey of many of my friends and colleagues who left their homeland behind to follow a dream. Opened their hearts and mind to face changes and challenges.
And, in spite of all the hurdles, which they were prepared for, and also for those difficulties that they were unaware of, or unprepared for, have successfully re planted their roots on foreign soil and are now growing stronger and beautiful each day.
And this is why I wished to share this story of us all for us to reflect together how very strong and resilient we all have been.
We moved our homes and families, shifted continents, started new job in a very different mental health system, strived to carry our own culture and to pass on our cultural values to our children, whilst, simultaneously, supporting them to get acculturated.
We all lived through COVID, and had to rapidly re adapt to the kind of world none of us had ever saw or knew before, We worked harder as an overseas doctor, being very aware of the biases, prejudices and cultural and linguistic differences that play a significant role in our day to day life and deeply impact us directly or indirectly. This list is in no way exhaustive.
But, do we ever stop for a moment to give ourselves a pat on the back, or take a mindful moment to truly appreciate how much we have travelled and come a long way?
Again, I write this for us to do just that.
Psychiatric practice is very different here
I came to UK in 2019 August, full of excitement to broaden my knowledge of how psychiatry is practised in a western world. I was also understandably apprehensive of taking up this challenge at 36 years of age, leaving behind my very comfortable and respectable job as an Associate professor of psychiatry to become an Associate specialist in UK. I was not aware that I was in for a roller-coaster ride. Though, I wouldn’t have changed my decision of moving even if I had known otherwise.
When I landed in UK, I was not aware, as most of overseas doctors are not, that the psychiatric practice in UK is very different here than in our parent countries. We as doctors from South Asia are trained very differently and work very differently in mental health in our home countries. We may have had extensive clinical experience of working with clients, this however, is in itself not enough when one starts working in UK. And, I now retrospectively think that this is probably the first and foremost challenge at the workplace that an overseas doctor faces.
Working in mental health in UK is so much about getting to know the system and forming professional relationships. Most of the mental health is delivered through multi disciplinary teams, and role of a psychiatrist is more than a doctor, it is that of a leader. This sounds so simple and straightforward on paper now, but to reach this understanding is a journey in itself.
Adapting takes years, not months
Undeniably, there are strengths in UK model of practising psychiatry, it takes time and patience to come to that understanding - MDT approach to clinical, more flexibility in terms of how you work and your style of working, regular strive to use evidence based and research based treatment options, appraisals, peer group support, all these are very much part of practising here.
It took me years rather than months to slowly adapt to the new system of working and to be able to respond to it reflectively and confidently. As an overseas doctor we bring our clinical expertise, our experience, our enthusiasm and also our passion for the work.
We also bring in our cultural richness and strength to the workplace. But, at the same time we also bring our differences. And, being different or not belonging to the majority in any culture or country has its challenges and thus, UK is no different.
To name a few, challenges for any overseas person that joins includes cultural shock, social isolation especially initially when one is trying to establish oneself and have limited time, understanding the nuances of social differences. Language difference, even though as an overseas doctor you may have been educated in English.
Challenges with the language
The very fabric of English and the way it is used is different and that makes it difficult to pick cues from the communication around initially. In psychiatry, we all know, ‘communication skills’ is a necessity rather than being simply desirable.
And, not able to fully comprehend or respond in the language / dialect that client speaks can leave one feeling in confident and also leaves one vulnerable and easy target for being judged or discriminated. As an overseas doctor one may not feel included in conversations or feel more of an outsider even though it may not be intended by the people conversing, due to this initial barrier.
I also do believe that that also may be the reason that doctors from minoritised ethnic backgrounds have more complaints with GMC. One of the probable reason is that how we communicate in English may come across as blunt even though it is unintended. I am not sure people fully comprehend that or are accepting of that, and definitely no one addresses this openly when doctors are recruited from overseas. It is my personal opinion that there needs to be more open communications around this aspect, especially, as there remains a high drive for recruiting doctors from overseas.
Within six months of moving to UK, we were into COVID. Needless to say, this wasn’t something anyone was prepared for. Everyone had to respond and adapt to working and living with COVID. Fear for one’s own safety, and worry about the health safety of family here and back home was a constant.
For 2-3 years there was little social contact outside work. Doctors who moved in just before COVID or during COVID had little chance at developing relationships at workplace and outside, this p delayed the social adaption and workplace adaptation by years.
What kept many of us going was what I described and wrote about- ‘RAINBOW’- R- Resilience, A- Adaptation, I- Introspection, N- Networking, B- Being responsible for one’s and others safety from COVID, O- Optimism, W- Withdraw from information overload.
Motherhood for the second time
I also embraced second motherhood during COVID. This was my second child, but first away from home and family. It was cherished but again, coming from a culture where women is surrounded by family and friends, supported and nourished in every way possible during pregnancy and postpartum, experiencing second pregnancy in COVID restriction and away from family was isolating.
Also, I must add here that as an overseas doctor with south Asian roots it is very likely that many of us get trapped in the narrative of feeling guilty for taking time off for pregnancy and postpartum.
Right from the time that we can remember in our lives we have had the sense of duty and responsibility and ‘never say never to work’ themes conveyed to us so many times that not actually working and still receiving something in return can send us into spirals of guilt. Even though one understands that it is alright.
What further got delayed by years was my application for CESR, Certificate of eligibility for specialist register. When I joined in my post, I was already working at the level of Associate Professor and in psychiatry for almost a decade, had ample experience in clinical work, research, teaching, leadership and thus was very confident that it wouldn’t take me much time to gather the additional evidence and experience that I would need from working in UK in my post as Associate specialist to acquire CESR.
I was convinced that since I was really working in capacity of Consultant psychiatrist, independently with very complex client group, with regular but very little need for supervision CESR would not be that big a challenge as others claim to be. However, multiple factors contributed to my delay in submitting my application. I only did submit it in May 2023, thus, almost four years into UK.
The massive task of organising and arranging all the relevant evidence in the way it is expected for a candidate must as per guidelines was a major delay, especially in view of time constraints that any full time working mum of a toddler would say, no matter whereabouts are the origins- south asia or elsewhere. From an overseas doctors perspective, I understand and appreciate that a process like CESR is needed to support and maintain the quality of clinical expertise available and there are drives to make CESR an achievable task.
But, at the same time, honestly, I cannot but help wishing it wasn’t such a monumental task to complete a CESR. Nonetheless, someone recently reminded me of a very old saying- when going gets tough, tough gets going. And, I am determined to achieve what I have hope to achieve, because I know I can.
Celebrating the differences and diversity
In a nutshell, my journey of four years in UK - a Women psychiatrist of South Asian descent, in NHS - has been full of changes and challenges, like of so many of us out there.
I truly am grateful for all the new experiences, learning and knowledge that I have gathered along the journey. My heart and mind is open to experience change and differences, ready to contribute my cultural richness to society and eager to accept and celebrate the differences and diversity that this new country will throw my way.
For we all are like wildflowers strong, resilient, tough, adaptive and thus can not only grow but flourish in most unique environments and places.