“…the ghost of my grandfather from the Outer Hebrides of Scotland is sitting on my shoulder. And he says, “ Ye dinnie deserve this, you better get up and earn it”
Robert F Woollard is Emeritus Professor of Family Practice at the University of British Columbia. He has extensive national and international experience in the fields of medical education, social accountability of medical schools, ecosystem approaches to health, and sustainable development.
In this he has or is holding leadership roles in the CFPC, CMA, AFMC, AMEE, and The Network TUFH. He is actively involved in Nepal with a national medical school, school of public health and a nursing school founded on the principles of social accountability established through his initial feasibility study. He Chairs the International Advisory Board (IAB) for the newly established University of Nepal (Dec. 2024) a new public liberal arts university. His work in East Africa and Asia is centered on matters of social accountability, primary care, rural health and accreditation systems.
Dr. Woollard co-chairs the Global Consensus on Social Accountability for Medical Schools (GCSA) and does extensive work in this area with many international bodies. He was a lead organizer for the World Summit on Social Accountability that led to the Tunis Declaration and recently chaired the Scientific Committee for TUFH2022 the annual conference of this network devoted to social justice and health, leading to the declaration https://thenetworktufh.org/tufh-2022- declaration/
He has engaged in a range of grant supported work including the establishment of CoPEH-Canada and the five year ECHO project on watershed scale integration of environmental, community and health. As an Associate Director of the Rural Coordination Centre of BC (RCCbc) he provided central leadership in the development of a Canadian national strategy for addressing educational and service needs for surgical and obstetrical services in rural Canada in particular Aboriginal service access for birthing. And, has worked in many areas to reduce racism in BC’s health system. Above all he is a husband, father, and grandfather.
Martina Kelly is a professor in the Department of Family Medicine at the University of Calgary. She qualified in Ireland, later completed her Master’s on reflective practice in clinical placement learning in 2007, earned an ASME travelling grant to the University of Alberta in 2010, and she moved to Calgary in 2012. Her PhD comprised a series of qualitative studies, using a phenomenological lens, on the meaning of touch in clinical practice. In 2022 she received the AFMC–Gold Humanism Award as a leading investigator in the nuances of human connection.
“When I was young, and I think it’s changed, I hope it’s changed, the sacrifices required for that good fortune were paid for by the family.”
Martina Kelly: Hello I’m Martina Kelly and welcome to MedicsVoices.com where we talk to key opinion leaders in health and medicine. Today we are talking to Emeritus Professor Bob Wollard who is based in at the University of British Columbia.
Your career has spanned such a large time, maybe more than 50 years and I wondered if you could share with us maybe two or three seminal moments in your career or that gave you insight and shaped the things you’ve done.
Bob Woollard: The primary one, that relates in some measure to my career in medicine was that, while working in a black hospital in South Carolina in the 1960s during the civil rights era, I met my wife of now 57 years. And, that is undoubtedly the most significant thing that happened. And I mention that because, in a sense, the career of medicine has opened up so many doors over time, all over the world, that I’ve been very privileged to experience.
I grew up in a poor and limited education family, but with parents that were obsessed with the idea that the way out of poverty was through education. Our job was to get educated, which we did, and I went to university after graduating from a high school with 12 others.
At the University of Alberta I was like a calf out of the barn in spring and took extra courses and was offered a position in medicine after two years. During those two years the Head of the Department of History mentored me and offered to get me into the London School of East Asian Studies, that was the premier school at the time. However, my high school principal said I should become a doctor, which was news to me because I didn’t really know what a doctor did except that they sewed up my finger and it hurt like fury.
I had to make a decision and, you may be interested to know that I’m only a doctor because of a pool shot, a billiard shot. Like a good colonial boy I went to a friend with a toffee British accent and said, “what shall I do, I’ve been accepted into medicine and I’ve been offered this in history.” He happened to be shooting billiards at the time and he said, “I’ll tell you what to do – if I make this shot, go into medicine, if I miss this shot, go into history.” And so…
He made the shot. It was a relatively difficult shot and I still remember the sound of the ball going into a pocket. I’m not religious, but that’s as close as I could come to thinking – maybe there’s some intention in the universe that I should do this. So, I did medicine, and had I not, I would not have met my wife, I would not have had the fortunate career that I have had.
“…the most fortunate career in life is that of a small town GP. The problem is that the worst job in the world is the spouse of a small town GP.”
And your question has made me reflect on what a fortunate life I’ve had in so many ways. Almost every moment of it has been very positive. But, at the same time, as I’ve often said to students, the practice of medicine is a little like crack cocaine, it can take over your life.
When I was young, and I think it’s changed, I hope it’s changed, the sacrifices required for that good fortune were paid for by the family. I was very fortunate because I was a country doctor for two decades while we were raising our children. My wife grew up in rural South Carolina and we didn’t think we were smart enough to raise kids in the city, and I think we were probably right. So, for two decades, I worked in a very small place. There was a little ten bed hospital. We were delivering 100 plus babies a year in that little hospital, and seeing all kinds of trauma and so on. What I would reflect, partly at the time and more so in retrospect, is that the most fortunate career in life is that of a small-town GP. The problem is that the worst job in the world is the spouse of a small-town GP. These both crossover because, after two decades there, it was time to move on. Our children had grown up and so on. And I moved to the university after that.
Again, I sometimes reflect that my wife uttered two, two-word sentences or questions, that changed my life at critical moments. The first one was obviously when she said “I do” when we got married. Well, what happened one day 20 years later is that, one evening, we were looking at the setting sun, along two rows of trees that we had planted and I averred, that when we retired this would be golden tunnels and rubies hanging on them and all this kind of stuff- and, she looked a little bit puzzled. And then she said, “Are you planning on retiring in Clearwater?” And then she added this second rhyming couplet “With who?” That was in October, and by March, I had a job at the University of British Columbia in the Faculty of Medicine, and we moved to Vancouver. So, those are the salient moments.
This may be foreign to you as an idea, but, as physicians we tend to take ourselves rather seriously and to think that it’s the medicine that makes us. If nothing else, I’d like to reflect at this stage of life that it’s just the fortunate vehicle of our lives. And, if we acknowledge that and, and try to maximize the sharing of that good fortune, that’s probably as good as it gets in life.
” If nothing else, I’d like to reflect at this stage of life that it’s just the fortunate vehicle of our lives. And, if we acknowledge that and, and try to maximize the sharing of that good fortune, that’s probably as good as it gets in life.”
MK: I’m going to shift gears a little because, one of the things I was reflecting on when I was thinking about your career was that an outstanding aspect of your career has been your ability, as a family physician coming from a small town, to really drive international conversations on topics of social consciousness, like social accountability, and sustainable health. And I wondered if you had any thought about the role of family medicine as a social agent for change?
BW: As it happened, I was practicing in this small town with a little ten bed hospital when a large uranium mining company from the East wanted to build a uranium mine in our town, at a time when regulation was almost absent because of differences between the province and the federal government. This fell between the two. So, I was called on to look at what the implications were. And it didn’t take a lot of research to know that it was going to have very adverse effect on life. Anyway, I became involved.
And, the power that is invested in a community, vested in a physician, the respect that you automatically get because of past actions of physicians and so on, gives you a remarkable degree of influence. And that very quickly grew to become a kind of cause celebre. At that time, believe it or not, I was a long-haired hippie doctor from the bush, which the media loved, and when I asked the medical association to get involved, they jumped on it and almost overnight I became a kind of a national presence. Moving forward, we eventually had, and still have, an embargo against uranium mining in British Columbia, notwithstanding, that there are significant deposits here.
Let me give you a story, which I think is emblematic of that…Before I was born, a great uncle who was a tragic survivor of the First World War. In the novel ‘All Quiet on the Western Front’ the book is dedicated to those who, though they escaped the bullets and the bombs, were nonetheless destroyed by the war. Well, I had an uncle who was destroyed by the war. What happened was that, in this very small rural area, he was jealous of another chap around a woman and he mailed poison chocolates to this chap. There were two bachelors living in a shack, and the other bachelor happened to pick up the mail that day, opened the package and, anyway, he died. The point of that is that the chap that he was trying to kill later became my patient when he was an old man and I was a young doctor. And, as I frequently say to folks that are interested in listening, he didn’t trust me because I was a Woollard, (I shared my uncle’s last name), he trusted me because I was a doctor. And I have to earn that every day. It’s that kind of thing that opens doors, and the responsibility that comes with that.
Being a general practitioner means that you need to be constantly listening and adaptive from one patient to the next. One just wants you to fix them, like your car- they come in, tell me what to do, give me the prescription, I’m out of here, and don’t ask me a bunch of questions about my life. And the next patient is, going to come to you for much broader sense of who they are, what health means to them, and you have to adapt to that. In the political sphere, it’s not that much different, that adaptation. And, I’ve been fortunate enough to be in a situation to get involved with a lot of international work, I want to acknowledge in particular, Charles Boelen, who was the sort of father of social accountability movement in medical schools. I learned a lot. He is a very valuable friend and continues to be a very valuable mentor. And the idea of social accountability, which is essentially ‘being useful’, at the level of the individual physician, be they generalists or specialists and so on is, I think, a reflection that we can be useful and we can be useful in different ways, and we need to be useful.
If you take that up a step, what about the institution that trains us? What about the university that creates the physicians of the future? Not old guys like me, but young people with a very different set of capacities, with a very different approach in a very different society, a society that one might even say is going mad right now. It becomes, incumbent, I think, for those privileges and for that institution, to also be useful,
The historian in me reflects that medical schools began in Padua in the 14th century at a university but, why the heck should a medical school be at a university? If it’s a training school, why should it be a university? Well, it happened and as a consequence, the profession meandered through and, although it has still retained at faculty level a lot of those kind of 14th century Catholic Church hierarchies as opposed to a community of scholars, it has also at the same time developed the capacity to influence the society around it. So, as we have individual responsibility, I think there is this collective responsibility to be useful.
“And the idea of social accountability, which is essentially ‘being useful’, at the level of the individual physician, be they generalists or specialists and so on is, I think, a reflection that we can be useful and we can be useful in different ways, and we need to be useful.”
MK: So many people are faffing around trying to define social accountability, I love the way you were actually able to describe it with this one liner – ‘Just Be Useful’. That sounds pretty good to me.
Perhaps riffing a little bit off your story of your uncle, but also more seriously, on the title of your book, “Fatal Consumption- Rethinking Sustainable Development.”, I wondered what made you think about this idea of fatal consumption, and reflecting on that in relation to primary care, the role of family doctors and things like that, it’s a pretty gripping.
BW: Well, I moved to the university as I said in 1989, and what I found there was remarkably fractured, specialized, with isolated silos of knowledge. Coming from a very uneducated family that was a shock to me because I had always revered the ivory tower on the hill. And it happened to coincide with the publication of the Brundtland Report, which is a major United Nations report led by Gro Harlem Brundtland, who was at that time, the past prime minister of Norway. And it was about to the idea of sustainability. The idea is, as she wonderfully simply put it, not using today those things that our descendants are going to need for their welfare. Not that we’re good at it, not that we even acknowledge our responsibility in that, but nonetheless, it was a clarion call. And, when I looked around, it happened that the president of UBC at the time was the chair of the roundtable that was to be Canada’s response to that report about sustainability. They were discussing -should we bury PCBs, should we burn PCBs, etc. And I, not realizing the hierarchy, dropped a note to the president saying- how can you talk about sustainability without talking about health? And he turned it back, and said, “Why don’t you get together a task force and put that in the process?” So, putting it together, I thought I guess we’ll need Nursing and Medicine and the School of Planning and Social Work etc. So anyway, we brought together leading people who are I think were just amused that somebody like me would be inviting them.
And here’s the conjunction of human angle as well. My wife, bless her, because we’d grown up in the country and because you didn’t invite people without feeding them, said, “Well, you can’t have these people coming in without feeding them.” And she made, which has now been famous in my life, a Salade Niçoise, and so all these heads of departments and associate deans and staff came into this room, and they had such a salad. Anyway, that was the genesis of what ultimately became the book. I edited and wrote the basic pieces, but essentially it was those people who became involved in that task force, which was called the ‘Task Force on Healthy and Sustainable Communities’, because it was very obvious to me that there is no way that interprofessional work could take place until you got to the community.
The academic culture at the time was, and to some extent still is, of people talking past each other using the same words for different concepts, or using different words for the same concept, without even realizing it. But once you get engagement with the community, then you’ve got something. The essence of social accountability is, as Charles defined it, that connection to universal, to the community. Because how do you know what their needs are? How do you know what their wants are? How do you know what their health is if you don’t talk to them, if you don’t engage with them?
There’s also a part of the academic culture that I found quite disturbing at the time, and that was, the capacity of the academic culture to sit around and whine. It’s the nest of the classic ‘whine and jeez party’ that said, “if we only had the money we could…. “ And this is without realizing that in an academic institution the Faculty of Medicine gobbles half of the money. Its hugely fortuitous where we are situated because the idea of health does have, and should have, a universal appeal. Anyway, that realization that there needed to be engagement not consultation and engagement of the community became a bit of a watchword
And then, by chance, I began working in Nepal, developing a medical school there that was focused on rural and lower caste health. That’s been remarkably successful and, in fact, this morning I was in Kathmandu, virtually, because we’re in the process of establishing a university. And, here is an example, You remember the pool shot I mentioned? Well, I chair an International Advisory Council of folks from more than a dozen universities around the world; MIT, Harvard, Munster, University of Tokyo, etc., – a group of folks who are developing a liberal arts university. In fact, one of my closest, working colleagues on it is, an historian from MIT. And, so it’s again an example of good fortune and an example of why one owes that good fortune something in return.
Sometimes as I wake up beside this wonderful woman for 57 years, and the ghost of my grandfather from the Outer Hebrides of Scotland is sitting on my shoulder. And he says, “ Ach laddie, Ye dinna deserve this, you better get up and earn it”
MK: I think that’s really great. It’s been wonderful talking to you. And thank you so much for telling us about your life, and inspiring people, because many people might see that the ability to speak up actually is the power to change the world. I feel that’s quite inspiring at this moment in time. So, thank you very much.
