When Doctors Get Traumatized Practicing Medicine (Part 1) – Dr. Rola Hallam – HPP 133

SPEAKERS

Dr. Rola Hallam, Dr. Will Van Derveer

 

Dr. Will Van Derveer  00:11

Welcome back everyone, and thank you for joining us for the Higher Practice Podcast. I’m Dr. Will Van Derveer with Keith Kurlander and this is the Podcast where we explore what it takes to achieve optimal mental health. For today’s episode, we were joined by Rola Hallam, an activist physician in the UK to talk about her personal journey through recovery from trauma. Although we’ve made a lot of progress in the physician community toward acknowledging our own personal traumas, there’s still a lot of work to do for us as a profession, to honestly appraise how impacted we are as healers, ourselves, and how scarce these conversations are amongst us about this silent epidemic. Rola Hallam, if you haven’t heard her name before, I’ll be a little surprised her videos on the internet have been watched about 10 million times. She’s a physician, whose work you may know she has a popular TED talk from 2018. She’s dedicated many years of her professional life toward relief work in war zones, including Sub-Saharan Africa and her homeland of Syria. Dr. Hallam has been honored with several awards and is also the first Syrian TED Fellow and the founder of CanDo, a humanitarian organization that supports frontline health and to aid workers to save children’s lives in their war devastated communities. She has helped build seven, that’s you heard me right, seven hospitals in Syria, including the first ever crowdfunded hospital altogether reaching over 4 million people. Rola is a tireless campaigner for the protection of healthcare and children caught up in conflict as well as for the critical need to focus on the health and well being of frontline health and aid workers. Rola is sought after as a transformational speaker who has shared global stages with presidents, celebrities and grassroots activists. Her work has been published in The Lancet and featured across the media, including the New York Times, The Daily Show, and in two BBC documentaries. Hello, Rollo. Welcome to the show.

 

Dr. Rola Hallam  02:35

Thank you for having me.

 

Dr. Will Van Derveer  02:37

It’s such a privilege to get to have this conversation with you. I’ve been really looking forward to this for some weeks now that we’ve been planning this

 

Dr. Rola Hallam  02:45

Me too. Let’s do it.

 

Dr. Will Van Derveer  02:47

Great. Well, so the first thing I’d like to invite you to speak about is really to help our audience know a little bit about the context of you and your background, specifically, of course, I know that you’re an anesthesiologist by training. You’re in London, I believe, is that right? Okay.

 

Dr. Rola Hallam  03:10

That’s right.

 

Dr. Will Van Derveer  03:11

And I was born in Syria. And you gave an incredibly moving TED talk a few years ago. I would encourage anyone to go listen to that on YouTube, or anywhere that they want to do that. And I see you as really a powerhouse leader of change in the world. And so I’m really excited to hear about the inner workings of such a leader and how you came to be who you are first. And then we’ll go into more of what you’re into now and where you’re applying your energy to affect change in the world.

 

Dr. Rola Hallam  03:53

Okay, great.

 

Dr. Will Van Derveer  03:53

So, were you a young person who thought you know, I’m gonna grow up and be a doctor, or how do you relate to that question about getting involved in the practice of medicine?

 

Dr. Rola Hallam  04:06

I actually think I was born a doctor, because I remember growing up in Damascus, and playing with my siblings, and cousins and our Barbies and Cindy’s and insisting on being the surgeon performing the life saving surgery on them. And so when we moved to the UK, I was 12, I didn’t speak any English then. When it came to applying to universities three years later, my teachers told me my grades weren’t good enough and I should have applied to biology or chemistry instead, which I thought was preposterous. I was like, of course, I’m going to be a doctor. You don’t know me. And I applied and one medical school saw my potential. And here I am now 20 years later after qualification. I would say that I’ve always been driven by the belief that access to healthcare is a fundamental human right. And that I was, I think, aware of the fact that there were and have nots of it because of growing up in Syria. And so alongside of my anesthesiology training in the UK, I was always working in Sub-Saharan Africa, alongside local health providers to help bring wherever expertise and training I could or just lend a hand and be a bum on the seat as it were, and working alongside my local colleagues, whether it was in Uganda, Kenya, or Ethiopia. And working to reinforce that, yeah, local health provision as much as I could, and really add envision as a life in global health, and until the poor started in Syria and entirely changed the trajectory of my life.

 

Dr. Will Van Derveer  05:52

Wow. Yeah. That’s really helpful. Thank you for sharing all that. And so it sounds like this is a new layer. I didn’t know about you that you were very involved in global health and going to Africa, offering your services throughout. So it wasn’t the first thing that happened when the war in Syria started. It was sort of an exclamation point on what you were already aware of and working on.

 

Dr. Rola Hallam  06:20

I was very much working in a resource low setting. But it was in a development setting in a stable setting, and suddenly ours sort of catapulted. When in 2011, the peaceful protests calling for freedom and dignity were met with bullets and bombs and suddenly, war broke out across the country, and my family were affected from pretty early on. We lost over 30 members of my family in 2012 and in 2013. And I did the only thing I knew I could and I joined the humanitarian effort. And so I was working as an anesthesiologist in the UK, but I would then spend my evenings, weekends, and holidays, fundraising, on Skype, I remember Skype, building hospitals and clinics and doing whatever I could, and then in the holidays, I would go and I would do medical missions to help, do needs assessments, be a clinician, and help provide that health care and humanitarian aid. So it was, although it was still in the health sector and or in the health sphere, it was entirely different. It was personal for a start, it was personal for a start. And there’s something particularly traumatizing when you know that it is a fellow human being causing the suffering of a fellow human being. It gets one thing when I’ve worked in the context of a natural disaster like it’s just nature. But when it was a human being who knows they are dropping a napalm bomb and a score. Like there was something so deeply fracturing of that, that it made such a huge difference to the experience of being a provider in that context.

 

Dr. Will Van Derveer  08:20

Well, and did you go to Syria during the early conflict?

 

Dr. Rola Hallam  08:27

Yes, I would travel into northern Syria from southern Turkey, because going through Damascus was no longer safe. Pretty much most medics and aid workers who were daring to save lives of civilians in areas that were outside of government areas, which were the majority of where the war was happening. They were deemed traitors to the state and arrested, tortured or killed. And this is something that not many people know that Physicians for Human Rights have documented over 600 attacks on medical facilities in Syria, and nearly a thousand of our colleagues have been killed, 40% of them under torture for being physicians and health workers providing medical aid to civilians that the state does not want to be saved. And so I would go from the northern borders through Turkey. To be honest, the parts of Syria that I had never been to before that I didn’t know. And it was very eye opening to see that rural and ordinarily quite poor part of Syria. But now, with literally millions of the internally displaced people who had come in waves and waves from the southern parts of the country up towards Turkey in the hopes that they might be able to make it across the border to go to safe haven. It was during one of these medical missions that I witnessed so many war crimes, like a school full of children being bombed with a napalm bomb, and dozens of these severely burned children coming into one of the hospitals that we had helped to set up. I think one of the most devastating things to any health worker is when you know you are providing inadequate and substandard clinical care.

 

Dr. Will Van Derveer  10:35

Sure.

 

Dr. Rola Hallam  10:36

Like, I knew these children needed to be intubated and ventilated and sedated and sent in an ambulance. Fully monitored to a tertiary referral center to treat with their severe bands. And instead, despite the best efforts of my tiny team,we had to send many of them choking and in pain in the back of their parents’ cars. Children died that day, because I who had the knowledge, skill and ability to administer, potentially life saving treatments didn’t have access to those tools, resources and equipment that I needed and that deeply impacted me, but it would take years for me to figure out that actually, it had traumatized me, because I think so many of us normalize, and just get on with the traumatic stress and the traumatic incidents that we experience, because to us, it’s normal.

 

Dr. Will Van Derveer  11:34

Right. It’s normal and the experiences or symptoms we might be having or not, even if we have a clinical background, and we know what PTSD is. We don’t fit into a category, we don’t recognize. Maybe we’re not having flashbacks, or we’re not having nightmares. We may be having physical symptoms or other manifestations of trauma.

 

Dr. Rola Hallam  11:59

Yes. Absolutely. I mean, I think when I eventually did fall into a valley of what I initially called bournout, and then realize it was just a mountain of undealt with grief and trauma that had taken up every home and every cell of my body. I’d realized that not only had medicine and my training not really prepared me to prevent, recognize or manage it but it didn’t really provide me with the tools that I needed to heal myself. Like, I feel like somehow medicine has moved away from healing, even we’ve become about super specialists care that sees a part of a physical body and the wholeness is left at the door. It’s like we, like Flat Earthers, we see like the two dimensions of a body and then we forget, energetic, we’ve forgotten the spiritual and the emotional, or at least that’s what it felt like, now. But yeah, to your point about the trauma, I honestly used to tell people, like, it’s amazing how traumatized. I am considering how much I’ve been through and how much I’ve seen. Like, I genuinely believe that because, like you said, as I’m not having flashbacks, and I’m not having nightmares. I’m functioning, I’m highly functioning in fact. I didn’t realize that the nasty voice of shame that plagued me was trauma. I thought that was just like normal guilt that was keeping me from being a good activist. Like, that voice of like, How dare you? How dare you think you have to get back to work? That nasty, like I had no, I always used to be like, okay, yeah, you’re right. Like, who am I to complain? Like, just get back to work? And it took me a long time to realize that that was a manifestation of trauma. Absolutely. They’re sneaky.

 

Dr. Will Van Derveer  13:06

Yeah, they are sneaky. And I would say, in a life and death situation, those parts of us could be life saving to focus us on survival. Unfortunately, once those voices as you say, take up a home and the cells in your body. They don’t retire when the life and death situation has ceased and they persist, and so we, until we get the right kind of care and attention. One thing that comes up for me: I’m curious about you having been trained in the UK in medicine over here, with the I guess we call them The Yanks. We’re heavily traumatized inside of medical training itself. There’s a culture of shaming medical students that’s very toxic. And so, when you talk about medicine not offering you the tools or the ways of even understanding your experiences of trauma. Part of what I relate to over here as an American physician is also the layer of essentially being told that if you don’t have your shit together. If you’re not a rock solid, unemotional, unassailable person with all the answers for this stuff of people, then the messaging is your worthless physician. I remember reading Atul Gawande, his book on Being Mortal. There was a line that just hit me right in the face of the physician who doesn’t have the answers as a worthless physician. That’s exactly how I felt in training. Anyway, it’s another layer of what I think you’re talking about. And is that the same in the UK for physicians coming up through training? Would you say?

 

Dr. Rola Hallam  16:13

I think that we traumatized professionals within a traumatized profession. And this is the problem is that this is what you described, and that shaming is someone else who’s been shamed. And they’re now just passing it on. Until we as a profession realize that, what we are calling burnout is not burnout as trauma until we actually start to recognize and manage that and break that cycle. We’re going to continue to pass that on to the next generations. I didn’t ever at any point. There’s definitely a bit of that shaming here I think. I don’t know how it would compare, but there is still the problem of poor leadership when it comes to your own health and wellness. I have never had a senior tell me to look after myself about boundaries, about self care. They don’t model it. Actually, I think the new generation now is looking for more life balance. And actually, the older, more senior members are like, What the fuck? What do you mean? Life balance, Like, I don’t have work life balance, you should. You’re not gonna get work life balance. And if I’m expected to work 24/7. I’m sure hell you’re expected to work 24/7. And so, how dare you? And it’s partly why I feel passionate about speaking out about not only sharing my experiences, but becoming one of these voices that says, we need to reimagine medicine, how it is to be a healthcare professional.

 

Dr. Will Van Derveer  17:55

Yes.

 

Dr. Rola Hallam  17:56

Because right now, we are taking so many of us. I mean, this was one of my most profound realizations when I kind of recovered, I guess. I just looked around and I just saw myself treading water trying to drown in an ocean of banter and traumatize our profession.

 

Dr. Will Van Derveer  18:15

Let’s go back to that time. If you’re open to it, I’d love to hear about how you moved from calling what you were in burnout to, oh, wait, there’s something else here. Can you describe that process?

 

Dr. Rola Hallam  18:29

Well, first of all, I think when it first happened, it happened in such a strange way. It was the 10 year anniversary of the war in Syria. I was doing a BBC interview and just released a second BBC panorama documentary, and I suddenly had an out of body experience. I was looking at myself during the interview, and I was like, What the fuck? I’m still doing this? After 10 years, I’m still talking about hospitals and schools being bombed? And it was like a moment where my brain just went, I just couldn’t compute anymore. It was like, I felt like the biggest failure that had ever existed on planet Earth. It was like I’d lost my sense of purpose. I’d lost any sense of ability. I was exhausted. And it was like, it was the beginning of falling into that valley of darkness and so for a long time, I didn’t even call it burnout because I was just all over the place. I just felt broken like I was losing my mind. You’re sobbing for one minute. You’re furious next. You couldn’t think the brain fog was unbelievable. It was like think, think, think, as I felt like a homeowner. Like, what I used to be intelligent. How come I can’t rub two brain cells together right now? So then you’re like, Okay, well, I guess I must be exhausted. I need to take a holiday and then I kind of very quickly realize now This isn’t a holiday, I’m gonna cut this. This is 10 years of not dealing with any of the grief and trauma. This is 10 years of just acting through it of being an activist through it of suppressing, repressing, denying all of those things. And honestly, I didn’t know what to do for a long time. Because for a long time, for months, every time I tried to get near it, that voice of shame would come up. It was like a guardian somehow. Like, we just sort of like stopping me from wanting to deal with it. And so the first thing that was foundational and created the first breakthrough for me was when I started self-compassion practice. That was the first thing I remember. I sat down to do my own compassion practice. And for the first time, I turned on myself, and I was like, you have suffered so much, and sacrificed so much, and I just cracked me right open. And I just sobbed and sobbed and sobbed, but it was the first acknowledgement in years of my own pain and suffering and what I had been through myself. I recognized that there was something in that and so I just kept practicing it and practicing and practicing it. And the more that I practiced it, the more I was able to get closer and closer to my pain. And then the more that I was able to not judge it, the more that I was able to explore it. And then as I started to sort of explore different things like breathwork, psychedelic therapy, my own meditation and prayer. I’m a Sufis, so my spiritual practice was foundational in my own therapy. The gun was foundational. And I remember the very moment when I suddenly thought, I’m not in fight and flight anymore. And I had no idea that I had been in it for 10 years. And that was the beginning of me going, I need to look into this. What is this thing that I’m going through? So, like that was when the personal and spiritual journey relate to the professional journey of now looking into and learning about trauma and realizing, Oh, holy crap, I’ve been saying how traumatized I am. Well, it’s quite the opposite. I just didn’t know that all of these things were at.

 

Dr. Will Van Derveer  22:56

We look forward to connecting with you again on the next episode of the Higher Practice Podcast, where we explore what it takes to achieve optimal mental health.