Sunday, April 14, 2024

Cindy Haq | Global Health Champion

by Editor

“The Best Things in Life Aren’t Things”.

Dr. Cynthia (Cindy) Haq is Professor Emerita at the University of California, Irvine.  She has practiced as a family physician, teacher, and champion for health equity in the US, Pakistan, Uganda, and Ethiopia for more than 40 years.  She treasures time with family, friends, and in nature. 

 

A home visit in Kasangati

Cindy Haq was Chair of the Department of Family Medicine at the University of California, Irvine with a lifetime commitment to primary health care, community health and family medicine. She has developed programs in Pakistan, Uganda, Ethiopia, with the World Health Organization, and with governmental and non-governmental organizations.

Previously at the University of Wisconsin School of Medicine and Public Health she was the founding director of the University of Wisconsin-Madison Global Health Institute.and created and directed the Training in Urban Medicine and Public Health (TRIUMPH) 

She has received numerous awards and honours including two Fulbright scholarships, an American Academy of Family Physicians (AAFP) President’s Award and Exemplary Teaching Award, a Society of Teachers of Family Medicine (STFM) National Excellence in Education Award, two Arnold Gold Foundation Humanism in Medicine awards.

“I know you’re a doctor, you’re trained to treat patients. But”, he said “you could treat patients here 24/7 until you die and not make much of a difference. But, if every time you see a patient, you’re teaching one of my staff, then when you leave, you’ll leave something important behind.” And that was such important advice.

Watch the video, listen to the podcast, read the transcript below

 You’ve been known to wear a lapel pin that expresses your personal philosophy: “the best things in life aren’t things”?

Cindy Haq:  The best things in life are, in my opinion, relationships, connections, making those connections that are deep, that are real, that are meaningful, that are inspiring. As the mother of four now adult children, five grandchildren, I feel blessed and fortunate to have a wonderful family, a network of friends, of colleagues, of former students that are now out in the world doing wonderful things that I can feel a sense of connection to.

So for me, number one, it’s relationships. And then, you can add in experiences with those relationships, the magic really begins to happen because those shared experiences bring people together whether they’re good or bad. Sometimes it’s the most difficult ones that create the tightest bonds.

It’s all about the relationships, the connections we have, not just with people, but also with the natural world. And, what a wonderful blessing that we’re surrounded by nature and can touch and feel that connection every day.

“… I was thinking I could be a teacher, I could be a research scientist. But wow, I could be a doctor and maybe do all of those things. I could teach and learn and conduct research and actually help people every day. It became very compelling.”

 

DMacA: That philosophy has clearly guided your life. So let’s take you back to the very beginning and your life has been, in an academic sense, a little unorthodox.  Tell us about your interview for medical school.

CH: I was an undergraduate at Indiana University studying biology. And, as I was coming into my senior year, I was thinking I could be a teacher, I could be a research scientist. But wow, I could be a doctor and maybe do all of those things. I could teach and learn and conduct research and actually help people every day. It became very compelling. So, I went to visit my advisor, my academic advisor, and I really hadn’t thought my chances were great. I hadn’t done pre-med, but I applied and was invited for an interview. So I thought, now this is getting serious. Maybe I should get some advice.

I went to my advisor and I said, “You know, I’m going for this interview. Is there anything I should know?” She looked at me. I was wearing a pretty beat up blue jeans and a flannel shirt, and she said, “First of all, you must buy a suit. You can’t look like that and you must wear a suit.  On top of it, when she learned I was already married and I had a child she said “under no circumstances should you tell them that you’re married or you have a child because you definitely will not get in”. So I listened to her advice. I went and I bought a $3 suit, very ugly looking, but it was a suit.

I drove up to Indianapolis for my interview and sat, very nervously, in a room with all the students who were being interviewed.  I was finally called in to see a gentleman who introduced himself as a psychiatrist. He asked me a lot of questions about my motivation and my background, my interests and, at one point, he said, “Aren’t you a bit naive? Are you sure you know what you’re getting into?” And I said “Maybe I don’t know what I’m getting into. And yes, I probably, am, naive.” And we talked a bit. I didn’t have any doctors in my family. I hadn’t been immersed in that environment. But I just had this sense of that it would be a good fit. And then he asked me, “So what do you like to do in your free time?” And I froze.  Because, at that point I felt like a psychiatrist could read your mind. They had special powers and they knew exactly what you were thinking, whether you said it or not.

And so here I am in this moment… “What do you do in your free time?”

Remember, my advisor had said, “Absolutely. Don’t say that you’re married. Don’t say that.”

But, I knew he could tell because he would be able to read my mind. So, I after a moment of pause, I said, “Well, I’m married and I have a child and I love spending time with my family and being outdoors and taking walks and going for picnics”

And, well, that was it. I knew I’d blown it. I’d never be admitted to medical school. And I went home with my tail between my legs and told my husband, “Well, that’s that, you know, I probably won’t be admitted.” And a few weeks later I got a little thin envelope in the mail, which I was sure was my rejection letter. And I opened it and I found out I had been admitted. My admission to medical school was a bit of a shock, really, but I’m very grateful.

“My father was from India and my mother from Indiana. I had grown up partly in Pakistan. I’d seen a lot of poverty, and I knew that I wanted to be a physician working in areas of great need.”

DMacA: So you completed your medical training and after that you took the road less travelled…

 

CH: Well, in a way, yes. I knew I wanted to work abroad. My father was from India and my mother from Indiana. I had grown up partly in Pakistan. I’d seen a lot of poverty, and I knew that I wanted to be a physician working in areas of great need. And, to me, that meant I needed to go abroad and work. At the time we called it International Health now Global Health.

 

In those days, every other year, the Journal of the American Medical Association listed physician volunteer opportunities abroad. I went through that listing and found every place that would accept a family doctor with her husband and, by then, three children, I didn’t want to go and leave them behind. My family was, of course, so important to me. And also, since I’d grown up partly abroad, I knew it would be important for the children to experience life outside of the United States.

 

I was accepted to become the medical director of a rural health centre in Kasangati, Uganda. This was in 1986, at the end of a brutal Civil War. At the time, Uganda had about 13 million people and about 200 doctors; most of the doctors had either been killed or they’d run away because of the war. They were desperate so they would take any doctor that would be willing to come. That was my first job.

 

It was towards the end of my residency training that I was able to talk my program director into allowing me to take an independent elective in pediatrics in Uganda. And the project was to improve child survival.  At the time, one in three children were dying before the age of five. It was a very difficult situation. And so that was my elective in child survival. We went for three months. My husband, who was a good sport, agreed to come along, our sons were then nine, and four and my youngest, daughter Heather, turned two while we were there. So that was my first independent job. 

 

Most of my family and friends thought I was crazy.  And I thought I was crazy too, once we got there and I found out how difficult it was. I was quite naïve but, fortunately, we made it through that situation. And in fact, it was a game changer for our lives. It was very difficult, but it was also very rewarding and very inspiring. The people were so generous and hopeful and grateful for our presence, and they surrounded and protected us.

 

“It opened my eyes to the importance of public health, community engagement and collaboration with others, because this is work that doctors can’t do alone.”

DMacA:  As you described it, as a game changer. And I think someone, a mentor or a colleague said something to you that influenced your life. And it was, that you can’t cure everybody; but by teaching people, you can spread the word. So, tell me a little bit about your career as an educationalist, as an academic.

CH:  It was Josiah. He was the manager of that health centre in Uganda . He said, “I know you’re a doctor, you’re trained to treat patients. But”, he said “you could treat patients here 24/7 until you die and not make much of a difference. But, if every time you see a patient, you’re teaching one of my staff, then when you leave, you’ll leave something important behind.”

That was such important advice. From that experience, I learned that my willingness or interest in caring for patients was not sufficient to address the amount of need. There were so many patients and so much to be done that I was inadequate myself to be able to do these things. What would be more impactful was if I was teaching.  In fact, after I left Uganda after three months, I recruited some of my colleagues to work there.   And I was trained village health workers who continued to serve their communities. 

The work went on and within two years, even though I was there a short time, the child mortality was half of what it had been when I came. Part of the reason was that the war was over and food and clean water became available.

But, what I learned is that by teaching, I learned more than I taught.  The Ugandans taught me more than I knew. They knew their local culture and resources that I didn’t know.  I didn’t know tropical medicine. They knew that. And so that was really the beginning of my love of teaching. I already enjoyed teaching, but I realized it would be so much more powerful if my doctoring was connected with teaching.

And so this lovely dance of teaching and doctoring, reinforcement and questioning, seeking information, new information, was really so rewarding. And I’ve been able to do that in many different institutions around the world, first at Dartmouth, then back to the University of Wisconsin, in Ethiopia, China, Brazil, and so many other places where I had the opportunity to teach.  Supposedly I was teaching, but what I was really doing was learning and making connections and building relationships with people that have become my lifelong friends.

DMacA: You’ve described teaching and doctoring, but at one stage you thought, I need to become a ‘change agent’. Tell me about that role as a change agent.

CH: When I started medical school, only 10% of our class were women. Medicine was dominated by men, and it was very patriarchal, and doctors would give orders to nurses or patients, and they should do what they were told.

I realized early on that women were very mistreated as we came into medicine, we were told we didn’t belong. One of my professors actually showed pornographic images during his lecture presentations to make sure we were awake during class. We were harassed. We were mistreated.

And I felt if I’m going to become medical school faculty, I want to change the way students are taught.  They can be taught with kindness, and with support and encouragement. They don’t need to be harassed and ridiculed or mistreated to become good doctors. In fact, in my opinion, that was counter-intuitive, counter-productive.  And so, there was a different way to be a teacher as well as to be a doctor.

And I remember saying to one of my faculty early in my residency, that I’d like to be the type of doctor who makes decisions with patients instead of giving patients orders of what they must do, knowing that often they couldn’t follow those orders. And that faculty member said, “I actually don’t know how to teach you that, because that’s not something that we do”. So, part of my motivation to become an advocate or an activist was that I saw a lot of problems with the way medicine was practised. Medicine was taught in ways I did not agree with. I wanted to find different ways.

And then, as I looked out into the community, I found that there were so many things that needed to be addressed that were not about doctoring. For example, the children in Uganda that I treated who had diarrhoea and were dehydrated, it wasn’t because their mothers didn’t care for them or know what to do, it was that they didn’t have access to clean water. And so I came to the idea that the role of a doctor can be as a change agent to promote health in communities,  to work with community leaders, organizers, elected officials, just to point out some of the challenges in the community and to say, as a doctor, I see that there’s a need for clean water because I can treat all the children with diarrhoea and dehydration until I drop dead but children will still be getting it If they don’t have access to clean water.

It opened my eyes to the importance of public health, community engagement and collaboration with others, because this is work that doctors can’t do alone. But by joining forces with others, we can add our scientific training, our voices, our place in society that’s respected, to serve as advocates for community health. And so that became the theme of my teaching and practise – community engagement and promoting health at the community level, not waiting for patients to fall sick and come to the doctor. Although we have to do that because patients do fall sick and we do need to treat them. But we could take prevention out into the community and activate people in the community to become leaders for health.

“… we need to change the conditions of health professionals so that they can find joy in their work, that they can find support by connecting with colleagues… where they can look at the big picture and say, this is worthwhile, this is meaningful, this gives my life purpose.”

DMacA: Finally, I’d like to ask a question about the profession. You’ve talked about community, you’ve talked about public health, you’ve talked about global health, but you’ve also identified a problem within our profession, which you have described as ‘pathological workaholism.’ How are we going to sort that out?

CH: This is a serious and ongoing challenge for medicine around the world, particularly, I believe, in areas where physicians are very short supply. There are so many health professional shortage areas. I mean, of the 8 billion people in the world, we know that nearly a quarter of them do not have access to primary health care.  So, there are very serious health profession shortages. And part of the challenge of recruiting and training and retaining health professionals is burnout.  If health professionals are mistreated, if they’re expected to work extremely long hours, if they’re not given permission to take care of themselves and their families, guess what? They leave or they’re not interested in the first place because the work is too hard, it’s too damaging and it sucks your soul from doing the work that’s most needed.

I believe we need to change the conditions of health professionals so that they can find joy in their work, that they can find support by connecting with colleagues, that they can rejuvenate by having conversations like these where they can look at the big picture and say, this is worthwhile, this is meaningful, this gives my life purpose. And, of course, I want to keep doing this work because it brings me joy.

There’s a movement within medicine to address that workaholism, the burnout, the overwhelm, and to make sure that people who are health professionals have the support they need, the camaraderie they need, and find the joy in practice so they’ll continue this work for the long term. Life is not all about work and suffering. But there’s also a great deal of joy and meaning.

DMacA: I love that idea of bringing joy and meaning to our work. And clearly you’ve done that throughout your life. Cindy, thank you very much for sharing your life with us. It’s been wonderful to hear about all your adventures and your continuing involvement in medicine and health care.

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