As part of a series of blogs celebrating International Women's Day 2020, Dr Humaira Jamal discusses her journey from her childhood in Karachi, Pakistan to practising palliative medicine.
Growing up in Karachi, Pakistan in the '80s meant career options for young women were extremely limited. I was given two choices: medicine or teaching. In the end, I chose medicine because I thought it would offer me more independence.
My mother has always been one of my biggest supporters; she is my hero. She wanted all her children, especially her daughters, to be educated. Not only that, she wanted us to be educated in an area that would provide us with good careers.
My mother married my father through an arranged marriage at a very young age. She did not get the chance to complete her education, which I think is why she strongly encouraged us to study and achieve academic success. Her drive and passion were inspirational when I came to choose my career . My father was also a huge support and – despite the financial strain – chose to send all his children to the best schools and colleges, to give us the best possible start in life. My two sisters, who have been incredible role models, also went on to pursue their dreams: the eldest is a professor of microbiology and our middle sister is a professor of sociology.
I studied hard for my pre-medical exams, and achieving the necessary grades for medical school was a big achievement, especially as a woman. At that time, women were competing for 100 medical school places, compared with 400 places offered for men.
Karachi’s Dow Medical College was a completely new experience for me, and was the first time I had experienced a co-educational institution. It wasn’t all smooth sailing though; the 5-year programme was extended by a year, as political troubles forced the college to close. These were intense and formative years for me, but it was also during this time that I met my best friend, who later became my husband. After 6 years, I successfully completed my degree and went on to complete a year of house jobs in Civil Hospital Karachi.
At that time, women were competing for 100 medical school places, compared with 400 places offered for men.
Unfortunately, there were limited opportunities for postgraduate training in Karachi in my chosen specialty of diabetes and endocrinology, and so I soon decided to look further afield. I was fortunate to be awarded a scholarship to pursue postgraduate medical training in the UK.
However, before I could even set foot onto UK soil, I had to pass the dreaded PLAB exam (a compulsory test for doctors who have qualified overseas and wish to practise medicine in the UK). It was the first time I had ever failed an exam, and I was completely devastated.
I decided to study for my doctorate in diabetes and endocrinology at the University of London, as gaining this qualification in the UK meant I wouldn’t have to re-sit the PLAB in order to practise. When I graduated, I felt like I was finally on my way to becoming a consultant physician in my dream speciality. I spent two and a half years doing SHO jobs in various hospitals in London. I was struck by the high quality of healthcare in the UK, provided free of charge. This was unheard of in Pakistan, where a ‘free’ national health service consists of government funded hospitals that lacked the basics and included high cost antibiotics and blood transfusions. Patients and carers were regularly asked to buy their own dressings and syringes.
My dream wasn’t quite a reality yet though, as I still had to secure a training position. After losing count of the number of interviews I attended, only to be declined, I was told to look outside of London or pursue a different specialty.
This was the lowest period of my career. Thinking I had run out of options, I received an unexpected phone call that changed everything. An agency were offering me a locum position in palliative medicine – an area I had never heard of. I met the consultant who would be in charge of my training, and this consultant became instrumental in my decision to pursue palliative medicine. For the first time, I found a medical specialty where I was valued for who I was. Whereas I had felt that my background was a barrier to getting the best jobs, I now saw that my personal story was central to the contribution I could make.
The defining moment came when I was talking to an Iranian lady with terminal myeloma. She had severe pain and was not responding to the strongest painkillers. She wanted to tell me her story, as she felt that, unlike other staff looking after her, we had a similar background and I would understand.
After spending an hour with her, I noticed her need for pain medication reduced dramatically and she died peacefully a few days later. This was the moment I began to understand the concept of total pain, which defines pain as a multifaceted symptom. It was only when her psychological pain was addressed that she became comfortable. I knew I had found my calling and have not looked back. I see it not as a job, but a vocation.
While medicine wasn’t the easiest path I could have chosen, it has come with many rewards. My advice to women wanting a career in medicine is to always have a dream and to never let that dream go – you will get there! Treat failure like water: do not fear it, but find your way around it by using the obstacles in your path to your advantage.
