Better Health For All

For me, the journey as a public health registrar began with an exploration away from clinical medicine in 2010. I first started to contemplate a career in public health when I was still at medical school, inspired by a friend who was thinking about going into the specialty herself after she had done her ‘elective’ in Sierra Leone. (Somehow she ended up becoming a breast surgeon but never mind!)

After that conversation I reflected on my own elective in India, and my friend’s sentiments resonated with my experience too – the seedlings of a career in public health had been planted in my mind.

Despite this, I knew I wanted to get some clinical work under my belt first and paediatrics was the obvious choice as my passion for child health started when I was a sixth-former and worked as a regular volunteer in a respite home for children with severe learning difficulties.

Fast forward five years, and I had completed 3 years of specialty training, membership exams and borne witness to the fairly extreme highs and lows of paediatrics, seeing children die being an experience which really stays with you forever. I had also worked rotas involving 1 in 2 weekends for 24 months, rotas which were constantly over-stretched and under-staffed.

But often the most frustrating aspect for me was that things could be done differently. Being so busy I rarely had chance to use the toilet let alone sit down for lunch, I wondered if the 2 week-old baby with prolonged jaundice (likely due to breast milk), really needed to be seen in the same setting as all the acutely unwell children. Or if the kids referred by GPs with diarrhoea and vomiting could have their fluid challenge at home rather than in hospital. Or if something could have been done to prevent the babies born 12 weeks prematurely from being preterm in the first place. Many of these babies made it, some didn’t but all of them experienced countless interventions along the way.

Public health was definitely the career choice for me but it was with a heavy heart that I left paediatrics and I will never forget the Training Programme Director’s parting words: “It’s a revolving door, you can always return”. But I was pregnant and glad to be doing a job that was stimulating, proactive and afforded me a better work-life balance than I’d ever experienced before.

Through public health training, I have learned so much and passionately enjoyed my work. All that I now understand about wider determinants, health inequalities, access, care pathways, integrated/person-centred care, wellbeing, prevention and social prescribing have helped me to make sense of my 5 years on the frontline.

However, those clinical years are now some time ago and things move on. In addition I have felt increasingly that the public health ask of frontline staff can sometimes seem overwhelming and yet I recognise that there are golden opportunities to make those crucial contacts really count.

To reconcile this, to see how things have moved on and because I missed it, after 8 years I have recently returned to the frontline as a specialty doctor in community paediatrics, undertaking a clinic per week alongside my training in public health.

It’s early days. There have been some ‘typical’ issues to do with IT etc., but I am very fortunate to be supported by lovely colleagues who have known me for a decade or more.

The patients, and their families, are fascinating. There is a richness to each story – often shared with me via an interpreter. The social determinants of health are illustrated in every story – both the resilience that comes from strong, loving supportive relationships and the consequences of isolation, poor housing and poverty. And as far as putting public health into practice goes, for each family there may be multiple issues. But often at a given point in time, there is one issue which is most pressing – and this may be a felt need, an expressed need or a normative one. The art of public health on the frontline is to work out and try to address that particular need.

Written by Dr Amrita Jesurasa