IMG persevered in following path

This essay, “Kamila’s Reflection,” is an excerpt from At the Interface of Culture and Medicine. by Kamila SaieedI AM ONE OF the international medical graduates (IMGs) who came to Canada following their dreams of a peaceful life. I am originally from Egypt, where I graduated from medical school in 1986. I worked there for a few years then moved to the Sultanate of Oman, where my husband worked, after I got married. I worked and gained most of my experience there.My family and I decided to immigrate to Canada in 2001. When we applied we were informed that we’d have to go through an interview. I was told at that time that Canada’s demand for physicians wasn’t high, and I had to sign a document stating that I would not be able to work as a physician and that I had no right to complain. I went home thinking about it. I always loved my job, and I wondered, “What will I do?” At the end I decided not to think about it and to leave it for the time.The day came when we had to leave Oman and begin our journey to Canada. I lived in Oman for more than 10 years, and it was difficult for me to leave my friends and my patients. It was a very emotional time for me. Thank you letters, gifts, goodbye parties were thrown to wish me the same success that I had there.When coming to Canada, we knew that we’d have to start from the beginning. It was so difficult to accept this reality. I started asking people, and I searched the Net for jobs that matched my experience. I was told that things were changing for immigrant physicians. At that time I knew about the Alberta International Medical Graduate (AIMG) Program. I started reading about it, and it sounded like an open door that could lead me to continue my career. I decided to challenge the exams, remembering what I was told in the interview and the document that I had signed. I felt discouraged for a while. But at the same time, I felt committed to myself and to my family to challenge the reality we faced at the time. I said to myself, if I had no chance at least I would feel good about trying.Alienated and depressedThe first year in Canada was the most painful time I had in my life. The culture shock was more than I imagined, and there are no words that could have described my deepest feelings. Homesick, alienated, and “depressed”—or at least that’s what my family physician told me. I disagreed with her diagnosis, knowing that I had an adjustment disorder. When times got rough, we questioned why we came. We had everything back home—friends to turn to when in need, families, a house, money, a decent job, a comfortable living. We doubted our reason for immigration. We had thoughts of re-turning. I started thinking of how I would feel. Defeated? Weak? Or would I feel happy to go back without achieving my goal? After my husband and I debated the situation, we decided to stay for a year and then revaluate our journey.Doing the Medical Council of Canada Evaluating Examination was the easiest step for me compared with what I faced later. After passing this exam, I decided to go looking for jobs. Everywhere I applied, I was asked the same question: “What Canadian experience do you have?” In one of the interviews, I was asked the same question and I had enough courage that time to tell them, “If you give me the chance today then I will gain it, if not I will have none.” A week later, I got a phone call from the manager who had interviewed me, informing me that they had a position for me.My first job in Canada was as a lab assistant in the microbiology department at Calgary Lab Services. When I started working there, I had mixed feelings. I was very happy to have my first job and started making friends at the lab, a very supportive group. But at the same time, when I remembered my job in Oman and Egypt, and how I was appreciated as a good physician, I cried. I wished I wasn’t here.During my work at the lab, I finished all the exams required and I applied for the AIMG Program. I was accepted. I left the lab with the wishes of good luck from my friends there, and with a gift: a pen engraved with “Dr. Kamila Saieed,” which gave me a push to pursue the dream that I had since day one of arriving in Canada.I started my residency knowing that my preceptor happened to be the AIMG program director. This made me stressed as I thought, this preceptor, he must have high expectations of IMGs. Language, communication skills, self-confidence, and a different system were but a few problems that faced me. I came from a culture where the patient-physician relationship was a parenting one; the physician would make decisions for the patient, give them a list of “should” and “shouldn’t” dos. It was different here. The patient–physician relationship is one of mutual decision-making.The first problem I faced in my residency was a written complaint from a patient who claimed that I couldn’t communicate well with her. This hit me hard. I had a flashback to the time when I used to work in Oman and how I was known to have the best communication skills, always the one to deal with the difficult patients. I said to myself, “I’m still the same person, but what has changed?” I needed to work on my communication skills to match the Canadian culture.Most of my experience was with women’s issues. In Oman, and most of the Gulf countries, the culture dictated that all women were to go to female doctors and men were to go to male doctors. In the beginning, during my training I wasn’t confident or even comfortable dealing with men’s issues and that was one of my weaknesses that I needed to work on. The first time I did a rectal examination on a male patient in my preceptor’s practice was a challenge. Taking a male sexual history was also initially difficult. With the support of my preceptor, I did learn these skills, in spite of it being very awkward at first.In the beginning, I found it difficult dealing with patients coming for an abortion. I was born and raised in a culture that always believed that abortion was not an option. It was perceived as killing. If a woman wanted to have an abortion, it was considered an illegal procedure and the doctor performing it would have a bad reputation, and in addition, he or she was subject to licence suspension if someone reported the case. Abortion was something to be done secretly. Moving to a place where abortion was made a right for any woman made me confused. I wondered how I could keep my beliefs without interfering with the care I would give to my patient. Not to judge others was one thing that needed to be clear inside me.I confess that I felt guilty when I was handling a situation like this. I always wanted to counsel the patient not to go for an abortion, to keep the baby or to give up the baby for adoption. When I did my rural rotation, I had a patient who came from another town because the physician in her town was not dealing with abortion or contraception. He made it a policy in his clinic, and she felt that he was judgmental. At that time I learned the lesson to help my patients as much as I can, not to judge them.Homosexuality was another difficult issue for me to deal with. Different countries deal differently with homosexuals. In the Middle East they were rejected, dishonoured. It was a shame for any family to have a homosexual member. It was considered something against nature. It was a very embarrassing question for me to ask the patient if he or she had any same-sex relationships, since I wasn’t used to asking such questions. It was a matter of time getting used to the culture and the different perspectives that came along with it.I worked with different preceptors over the two-year period of my family medicine residency program. With feedback from different preceptors, I realized how I had become a different person. “No self-confidence.” “Hesitant, but knowledgeable.” Those were the comments I initially received. I always underestimated my abilities and I was easily intimidated. I still remember one of the comments from my preceptor that made a big difference: “You need to verbalize your thoughts.” I had the knowledge, but I never had enough courage or confidence to speak. I would call this the “IMG tongue-tied syndrome,” as I was in contact with some of the other IMGs and they seemed to face the same problems.I got the chance to work with one of the preceptors who had worked in the Middle East, and he was familiar with the system there. He told me the first day I worked with him that physicians there memorize the facts, but they don’t know how to present a case. He was right, but at that time this was not what I needed to hear. I needed to be encouraged and supported. During my times of struggle, some preceptors were supportive while others took pity on me, which in turn worsened my performance. I thought to myself, “How will I make decisions and take care of my patients if I am that hesitant and have no self-confidence?” I was so stressed that I couldn’t focus on what I did.My second year of residency was much better than the first. Rural medicine was my first rotation. I had an outstanding evaluation, which was a driving force for me. I regained my self-confidence. The Simulated Office Oral (SOO) exam was one of the struggles I had. The SOO co-ordinating physician was very supportive. I owe her my success in passing that exam.At last, I passed my family medicine certification exam. I received my licence and am now qualified to practise as a physician in Canada. I was told this dream would be hard to pursue, and it was one that I always thought would be hard to achieve. But I did it.I’m thankful that I received my training through the AIMG Program. It is a stepping-stone for immigrant physicians to continue their careers in Canada.

IMG persevered in following path

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