Exploring again while on the field

I first encountered Dr. Kirsten Johnson when she presented at the 100 year anniversary of the Herzl Family Medicine Clinic at the Jewish General Hospital. I remember being amazed by her charisma and her fascinating work in the humanitarian field. I had the chance to chat with her about her career path.

After graduating from medical school at the University of Calgary, she pursued a residency in Family Medicine with an extra year of training in Emergency Medicine at McGill University. She went on to obtain a Master of Public Health from the University of Harvard. Her experience in humanitarian relief and research is extensive. Her journey has brought her to over 30 countries in conjunction with 16 organizations. Other than humanitarian relief, she is particularly interested in disaster response and human rights.

Currently, she is a staff physician in the Emergency Department at the Royal Victoria Hospital and works in Cree and Inuit communities up North. She is also an assistant professor in the Faculty of Medicine at McGill, interim director of the International Division in the Department of Family Medicine and an affiliate faculty member at McGill’s Institute for Health and Social Policy and at the Harvard Humanitarian Initiative in Boston. Dr Johnson is the program director of the McGill Humanitarian Studies Initiative that provides training to graduate students on humanitarian relief and disaster response.

Before, unprepared people decided to go on an international mission, most not even from the health sector, and found themselves controlling the lives of 40,000 people in a refugee camp all of a sudden.

To honour her outstanding work, she has received several awards including the Segal Centre’s 2010 Januscz Korczak award for her work in the protection of children’s rights in conflicts and the 2010 Award of Excellence in the category of global health by the College of Family Physicians of Canada. In 2011, she was selected as one of the Canada’s Top 40 under 40 by Caldwell Partners International that honours exceptional Canadians under the age of 40 showing outstanding leadership in their fields.

Why did you choose family medicine and more specifically humanitarian work and research?
“I chose family medicine and emergency medicine because I was on a path to do global health. Indeed, a lot of the care provided to the population in an international context is primarily basic with few resources. Most of the people doing international work are emergency physicians or family doctors because it allows you to work in specific segments of time and leave your job. I am not attached to a specific patient population that I have to find a doctor for when I am gone so I have more flexibility. The family medicine plus emergency program is the best suited to do global health because it gives you a broad base of skills and you can work in different scenarios.” She says that she specifically chose Quebec to better her French since a second language is essential in global health. She also admits that her master in public health was extremely helpful.  “If you want to do global health, you need an understanding of population health, epidemiology and biostatistics.”

Humanitarian aid

Her longstanding interest in humanitarian work in an acute setting led her to found the Harvard Humanitarian Initiative in conjunction with a group of emergency trained physicians who shared her passion. She says that humanitarian field work has significantly evolved in the last 20 years. “Before, unprepared people decided to go on an international mission, most not even from the health sector, and found themselves controlling the lives of 40,000 people in a refugee camp all of a sudden. There were many humanitarian catastrophes that occurred because of that.” This is what she wants to prevent by offering training in disaster response and humanitarian aid.

Could you talk more about the McGill Humanitarian Studies Initiative program?
« We are in our fourth year. Every year we get about 30 students, mostly medical residents. The course is designed according to a standardized curriculum and is a recognized certification worldwide. It is competency-based and it is linked to the Consortium of British, Canadian and American Humanitarian agencies. We train people to be effective in the field. We also offer more academic courses such as research methods and epidemiology. We run a field-based disaster simulation so students can apply the skills that they learn in the classroom. We linked the program to different humanitarian agencies to place our students so they get field experience in a supervised setting and so they can establish networking which is an important aspect in the field. This year, we are establishing a Canadian Consortium. We are trying to make one course this year to get everybody involved to standardize it and we will offer it throughout the country. It will be in Toronto and will last 10 days. Medical students could participate if they would like to. »

If you would like more information about the program, visit the McGill Humanitarian Studies Initiative.

What are your current projects?
« I just arrived from Kenya last week! My research field of interest is gender-based violence. We are doing a study to look at the politically-motivated violence. After the 2007-2008 elections, there was a lot ethnic tribal violence and targeted rape meant for people to vote certain ways. This is a new kind of gender-based violence that we are seeing. Nobody has really defined it as such yet.” She explains that it is a population-based study in order to provide evidence and data to inform policy makers. “We made a play with professional screen actors about our findings and we took it to the most affected areas, mostly slums all over Kenya where massacres of women and children had occurred. We had thousands of people come and there were even men who got up in stage and said that they should not do this to their women and how that would affect their community.” For her, it is rewarding to see that the results can have such an impact. She also recently started a consulting firm that is in charge of doing all the humanitarian training for different organizations such as the World Health Organization and UNICEF.  “It is the first competency-based training course that will be available through e-learning and will be THE certification course for everyone who wants to work in the field. We want to professionalize the sector. »

Camp in Uganda

What do you find satisfying in your practice?
« You have to look at it from different angles. A lot people think it is exotic, fun and adventurous. There is certainly a part of that. I like change, I like to be challenged. When you are doing clinical work in an international setting, it is rewarding because you feel that you have a direct impact on people’s lives. Doing public health research is different because it is almost discouraging. You don’t see the direct impact. You don’t see that your findings are actually going to make a difference. You may get published in a journal but that doesn’t mean that it gets translated to the people in the ground. But seeing the impact of the study like the play that we just did is extremely rewarding. I really believe that you can make a difference. I like advocacy. Intellectually, the research work is interesting. I also find it fascinating how we can train people to be better providers in the field and have a better standard. It is interesting to me to try to improve care and service delivery. I find rewarding to feel that I am making a difference but not necessarily through direct patient care. »

How do you prepare yourself for field work to ensure your safety?
« There are different levels of personal security. There is your own preparedness which is just experience, having travelled enough. You need to think about your own health and your own security (eg: insurance policy). When I take people to field work, they are my responsibility so I make sure that we are linked to an organisation that provides security. All pre-departure training is extremely important. You need to have a personal responsibility in reading and knowing about the place you are going to. You need to know the cultural norms and customs of the place. Normally, if you are working for an organization, you need to look into what security measures they are providing for you. There are more humanitarian workers that are being abducted than military personnel so it is really a risky job. At McGill, we don’t let students go to any Level 4 countries (Travel reports and warnings in the Foreign Affairs and International Trade Canada website). People cannot see global health as a free willing hitchhiking thing. You cannot take your security lightly. »

Humanitarian relief

What are the challenges faced in your practice?
Dr. Johnson admits that sustainability is an important challenge because it is a big financial commitment. “Most of the work you do in humanitarian aid is not paid. It sounds glamorous and fun but it is costly and has a personal expense (ie: your safety) so you really have to like it. It is nice to have people like you and have that collegiality. It is present in Harvard and Toronto. The problem in Quebec is the PREM system. I have many trainees in the HSI program, but there are just no jobs here. Most people end up going to Toronto. It is sad because Montreal is the perfect location because you get the language skills and you could have lots of job opportunities in all the different universities. ” She admits that it is also very challenging in the personal level. “I have to make choices. All of the global health part, you are not compensated for. So all that work that I am doing for free means that when I come home, I have to work very hard which means time away from my son and from things that I would like to do for myself. »

How do you manage to balance your personal life and your professional life?
« As a woman, it is very difficult to do because you are expected to be more with your children and at home. To balance family, clinical activity and research that takes me away is extremely challenging. What I do now is that I go for short amounts of time. So if people want to work in humanitarian aid, it is better to do it when you are young and you are finishing your training because you don’t have those obligations. After, it is much more difficult. This is why I went to research because I can do work from home and I can go to the field for short amounts of time. »

What advice would you give to students who are interested in humanitarian work?
« Try to find somebody who can mentor you in global health. Medicine is a great stepping stone. It is a great education and gives you a lot of credibility. If you want to do any work in a global health context, family medicine is a really good way to start. You get such a great foundation. If you want to cultivate a good platform of expertise and knowledge, it is worth considering doing a master in public health and a third year in family medicine. Getting your foot in the door and any experience that you can is also important. If you want to make the best of your experiences, make sure you are informed about what your expectations are and what you are going to be doing. There are a lot of organizations out there that aren’t very good and will put you in a situation where you are out of your comfort zone and won’t provide you with the learning that you need. The key is preparation and now there are plenty of opportunities to prepare you. I think that when you (medical students) graduate, there will be more mentorship if you want to do this type of career. »

Thank you Dr. Johnson for sharing your story with us and for your inspiring work!

Interview conducted by Carolina Capelle
McGill University