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Episode 2 - Dr Nisha Khot
159 Plays1 year ago
In episode 4 of Doctorama AMA President Professor Steve Robson chats with Dr Nisha Khot.
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Transcript
Migration and Family Impact
00:00:00
Speaker
Making the decision to leave your country, your friends and your family and move to another country is one of the biggest decisions we can make. It's a decision that can completely reshape our lives and importantly the lives of the family members who make the journey too. Making these decisions takes courage and they don't always work out. The stakes can be very high. Well today I'm going to speak with someone who moved between countries not once but twice. How did it work out for today's guest? You're about to find out on
00:00:34
Speaker
You're listening to Dr Rama with Steve Robson, bringing you the best of health, medicine and people.
Introducing Dr. Nisha Cott
00:00:42
Speaker
My guest today is Dr Nisha Cott, an obstetrician and gynecologist. And it's a pleasure to have you on the show, Nisha. Welcome to Dr Rama. Thank you very much for having me, Steve. And the first thing I want to do is congratulate you on your election as vice president of the Royal Australian and New Zealand College of Obstetricians and Gynecologists. Well done. You must be delighted with that.
00:01:03
Speaker
Thank you. Yes, I am happy and excited. Fantastic.
Relocation and Healthcare Systems
00:01:08
Speaker
Nisha, you studied in India and then moved to the UK quite a long time ago now. Uprooting moving between countries is a really big thing to do. Tell me about your decision making process at the time.
00:01:23
Speaker
So Steve, I'll be very honest. If I had my way, I would still be living in India. So my move was prompted by my husband's decisions and his decision was to move to the UK and then his decision was to move to Australia. So I'm being very honest that left to myself, I would still be living in India.
00:01:43
Speaker
That's a big thing. That must have been a big wrench for you, making that change. Did it cause any conflict with your husband at the time? It didn't cause any conflict, but yes, it was heart-wrenching, leaving my family behind and moving so far away. At the time, it was moving to the United Kingdom, to London, and then again, moving to Australia. I think moving to the UK wasn't as difficult because the UK isn't so far away from India, but Australia is a long way away from everywhere. And so that
00:02:13
Speaker
Yeah, I can imagine that would have been a big, a big wrench. I'd imagine that the health systems in your home, India and the UK, were different. Did you find that a big adjustment for you, moving between the two systems?
00:02:30
Speaker
Definitely it was a big adjustment. So the Indian system, when I trained, and remember this was a good now 25 years ago, was a very traditional patriarchal hierarchical system where you had to be very deferential towards all of your seniors, professors, whoever else it was. Whereas the UK was not like that at all when I moved there. And there was more of a friendliness to it and people didn't expect you to be, you know, almost servile.
00:03:00
Speaker
like we had been in india and so that was a culture shift it was you know instead of calling someone professor or sir or madam it was calling them by their first name which felt really really uncomfortable to start with. Did you when you were back at home in india have women in leadership roles or role models that you looked up to at the time?
Women in Indian Leadership
00:03:23
Speaker
So interestingly, Steve, India has had women in leadership for much longer than many of the Western countries, including UK and Australia. In fact, the first woman professor of ONG
00:03:36
Speaker
in India was long before the first woman professor of orangy in Australia. So we have a long history of women in leadership, which is very interesting because the stereotype is that the Indian woman or the woman from the subcontinent will be this quiet little mouse who will do what she's told and won't have anything to add to a discussion. But that is a stereotype. That's all. We are not like that at all.
00:03:59
Speaker
Well, Nisha, if it's any consolation, I have never thought of you as a quiet little mouse who keeps to herself. Certainly you don't fit that mould at all. You worked in the UK and then came to Australia from the UK. That's a big thing, moving your family between two countries in a few years. Was that a stressful thing for you at the time?
00:04:26
Speaker
yes and no. So the reason for coming to Australia or the plan when we came to Australia was that we were coming for a year and we would see how things were and we would probably go back to the UK. So the stress wasn't as much. It was like, yep, we'll go there. We'll see how it is. And if we don't like it, we have this place in the UK and we can always come back here. We are familiar with how things are here.
00:04:49
Speaker
But actually having landed in Australia and having lived in Melbourne for a few months, it became clear pretty rapidly that we were not interested in going back and that actually Melbourne suited us much better from its friendliness point of view, from the point of view that the weather was much better, and we also had some family here. And so it made sense for us to continue living here. And we've lived here now for 13 years and we are Australian.
00:05:16
Speaker
It's really interesting you bring up the fact that you had family here because my impression, India is a big exporter of doctors to the world.
Indian Doctors and Global Adaptation
00:05:26
Speaker
I think wherever you go, you find people who trained in India working. Is that your sense that there's a big diaspora of
00:05:33
Speaker
of indian doctors in particular and health care workers in general there's definitely a big diaspora of indian origin doctors and from all over the country and in fact the subcontinent so it's not just india it's shrillanka it's pakistan it's bangladesh there's a big diaspora from the subcontinent everywhere in health care across the world
00:05:51
Speaker
So that's probably because we have a very good training system which prepares us for emergencies and for surgical volume and medical complexity, so we are very well trained. And we're also, in a sense, good at adjusting to new places. We tend to find our own community, find our own groups of people we get along with, and we generally tend to assimilate very well with the wider community where we settle.
00:06:22
Speaker
During the height of the pandemic, in my AMA role on the Federal Council, we had some correspondence with the Indian Medical Association and they were looking for support and some of the conditions that they were telling us about at the height of the pandemic in India were horrifying.
COVID-19's Impact on Healthcare Workers
00:06:40
Speaker
Did you have friends or colleagues involved? And do you have any thoughts about how it played out in India at the time?
00:06:47
Speaker
Yes, certainly lots of friends and colleagues who were involved. In fact, I think if you speak to anybody of Indian origin, you will not find someone who has not lost a family member or a friend or a colleague to COVID during the height of that second wave of the pandemic. And yes, there were deplorable conditions and people soldiered on because that's healthcare workers we just soldiered on no matter what. But I lost an aunt.
00:07:14
Speaker
to the pandemic and you know there was no way of actually making any connections because nobody could go anywhere. Certainly from Australia we couldn't leave because we wouldn't get back and so that was really a difficult time to go through and hopefully it has given the Indian health system just like it has across the world all health system pause for thought and a rethinking and a recalibrating of our priorities and where we invest in health care.
Cultural Identity and Heritage
00:07:42
Speaker
Nisha, when you came to Australia, how old were your children? My older one was six and a half, seven, and the younger one was one and a half. How did they find that transition coming?
00:07:55
Speaker
from the UK to Australia and you setting up a new life here, was that easy for your children? I think they were young enough for them to adjust very, very quickly and now when I speak to the older one who should have some memories of the UK, those memories are very faint and as far as my children are concerned, they are Australian and this is the only country they really identify with.
00:08:20
Speaker
So they're pretty Aussie kids. I'm hoping they still value their Indian heritage and still really like to be part of that as well.
00:08:28
Speaker
They like the food, they like the celebrations, they like all the fun stuff, they like the fact that they're not restricted just to Christmas and Easter and that there is a festival to celebrate almost every month of the year. They like all of that. But if I were to honestly say I would identify as an Indian first and Australian next, they would identify as Australian first, Australian second, Australian third and maybe Indian fourth.
00:08:54
Speaker
So the big question is, do they support one of the cricket teams? Are they supporters of Australia or India? They support the Australian cricket team. I support the Indian cricket team. So when we go to an India-Australia match, we have to sort of agree to disagree.
Challenges for Overseas-Trained Doctors
00:09:14
Speaker
Nisha, when you came to Australia, you would have to have gone through the process both of immigration and having new qualifications.
00:09:23
Speaker
accepted him. We know at the moment, Robin Crooks just released a report looking at the processes for doctors who train overseas and come to Australia. And certainly, I think we all hope these can be streamlined. What was your experience of making that transition and coming as an overseas trained doctor to work in Australia?
00:09:43
Speaker
So I arrived in 2010 and APRA had just been formed and everybody was in a state of disarray as in nobody knew what the processes were and what needed to be done and so there was a lot of duplication and that still happens. There's still you have to submit a whole lot of paperwork to one agency and then submit the same paperwork to another agency and
00:10:07
Speaker
the one doesn't talk to the other and everybody has to do their own assessment of what you submit which just adds time, effort and stress when all as a doctor you want to do is start work.
00:10:19
Speaker
And ultimately what everybody is assessing is your recency of practice. Now, if you take six months going through the process of, you know, your paperwork being processed, then you have lost recency of practice. So that is not good for you as a doctor. It's not good for the health system because then you've had a gap of six months or eight months or a year, however long it has taken before you can get back into clinical practice.
Leadership and Systemic Healthcare Issues
00:10:45
Speaker
And so that seems to me like a silly way of doing things. If we want people to work, then we should make it easy for them to come and work. I completely understand that we have to be safe about it. We have to make sure that the people who are employed within our health system are good practitioners, safe practitioners, but we can definitely do it better. When you come to Australia,
00:11:08
Speaker
You took on a role at a hospital that had been through some considerable and very public turmoil and that was a big thing to take on. Tell me about why you took on the role and how it affected you and I guess what you did.
00:11:24
Speaker
I took it on very naively. In medicine, in our training, we are never taught about leadership. We are taught a little bit about governance, but we are not taught a lot about what it is to lead a poorly governed and a poorly managed unit out of that situation.
00:11:44
Speaker
So I was very naive. I thought to myself, I'm a good obstetrician gynecologist, so surely I'll make a good leader, which is my biggest learning that just because you're a good clinician does not mean that you are a good leader. Being a clinician requires a different set of skills. Being a leader requires a different set of skills. So that was my biggest learning. The second thing that we often do when we take on leadership is that we take on leadership in addition to clinical duties.
00:12:12
Speaker
And that is not a good thing because then you're burning that candle at both ends, which just means that you are the one who burns out, who feels like then they haven't achieved anything because you can't achieve two huge big roles and achieve them both successfully to the best of your abilities.
00:12:33
Speaker
And so that was my second learning that when you take on leadership, you do have to get that clinician to take a backseat, or at least you have to have enough time to be able to devote your energies to both those roles. You can't do both those roles 100%. That's just, you're not a 200% person. So those were my two top things. What I also learned was that this unit that I took on had no
00:13:03
Speaker
no issues that weren't existing in other units at the same time. And so it wasn't as if this was a place that was so highly dysfunctional that things went wrong because of the dysfunction. It's a system that doesn't work if you don't resource it well, if you don't have the staff, if you don't have the equipment, if you grow to double the numbers of
00:13:27
Speaker
births you do with the same amount of everything else, that's when disaster happens. It's not about a dysfunctional system. But the result of having something like that is that people who are involved are really traumatized, and then it becomes dysfunctional. So it's not that these were people who are dysfunctional to start with, but the way the system works, the end product of people who come out are dysfunctional because they are traumatized. And that was
00:13:55
Speaker
Such a sad thing to see that these were such highly motivated, really capable, and committed healthcare workers who bore the brunt of something that was systemic. And it destroyed their lives, it destroyed their families' lives, and it destroyed their commitment to healthcare that they had come in with. It is a tragic situation all around, and you are the right person to help tackle that and deal with it.
00:14:23
Speaker
As you know, I'm a big fan of your leadership, but a lot of doctors who come to Australia are likely to feel like they're on the periphery.
Advice for Aspiring Leaders
00:14:32
Speaker
They may well want to take a leadership role and maybe feel that because they didn't train here, they can't so easily take on leadership roles. What advice have you got for friends, colleagues, people who are in that situation? Like you who came to Australia,
00:14:50
Speaker
you feel like can't quite step up. What would you say to them? I think the first thing is to find good people around you. So just like it takes a village to raise a child, it takes a village to actually grow a leader. And so finding that village is a really important thing because those are the people who will encourage you, who will at some point say, no, actually you're ready for it. Why don't you go for it? So finding that group of people is really important. Finding mentors is really important.
00:15:19
Speaker
And my lesson again from this whole journey has been that I didn't have any mentor. And as an SIMG, as someone who doesn't belong, you just feel like, how would I go and ask someone, be my mentor? The person in front of me will say, who the hell are you? Why should I be your mentor? And so my experience of that was there was a very senior nurse who saw me kind of like a deer in the headlights and said to me,
00:15:49
Speaker
do you need some help? Can I help you with something? And she became my first mentor. And again, as somebody who's come from a very hierarchical system, I had to rejig my brain to think, actually, a nurse can be a mentor. Because for us, again, having trained in that system, my first reaction was, I'm a doctor, how can I have a nurse as a mentor?
00:16:12
Speaker
But rethinking that and actually accepting that somebody who has the seniority of experience within the Australian healthcare system is a very good mentor. And I really valued what she did for me and the help she gave me and the confidence she instilled in me just by being someone who was there to say, you know what, you've got this, you can do this. Come to me if something comes up that you don't know what to do about and we'll talk it over.
00:16:39
Speaker
That was something that nobody had ever offered to me. And so now I feel really strongly about putting myself out there and seeking when people are thinking of doing things, I'm like, yes, I will be a mentor. So I've joined a couple of mentoring programs, one through Ransco and one through another organization. And I'm really looking forward to repaying that, you know, that support that I got. Nishi, you're taking over as vice president of the College of OMG later in the year.
00:17:08
Speaker
I can't wait to see what happens next for you and how you go in that role. And I'm hoping that we'll have the chance to talk again once you've settled into that role. But I want to thank you for giving up your time to talk to us on Dr. Rama today. It's always a pleasure to talk with you, Nisha. Thank you very much, Steve.