Interview with a Leader in the Field

Interview with a Female Leader in Regional Anesthesia on Global Health: Shalini Dhir, MD, FRCPC

Aug 6, 2019, 15:38 PM by Melanie J. Donnelly, MD, MPH

Shalini Dhir, MD, FRCPC; Associate Professor, University of Western Ontario, Department of Anesthesia and Pain Medicine, London, Canada

 For Dr. Shalini Dhir, associate professor at Western University in Ontario, Canada, being a professional—and an anesthesiologist—was always an expectation. “My mother, a botany professor, was a great influence in my life,” Dhir says. “She was the first generation of women in her times to have worked and have a profession. Since childhood, being a professional was mandatory; there was no option out in our household! My father was an anesthesiologist, so my doing anesthesia was sort of predestined.”

Here is how Dhir has shaped a career as a female physician in regional anesthesia and global health.

How did you decide to focus your professional career on regional anesthesia and acute pain?

The brachial plexus appeared in 100% of my medicine-related exams, so I got the message! This year, I will be completing a masters in pain management from the University of Edinburgh. I think enjoying what you do is the crux, then everything else falls into place. My professional life did take a back seat when my daughter was younger, but once she went to university, it was back in the front seat.

Describe how you became involved in your global health efforts.

This was accidental. I met a few Canadians who had been very involved in global health efforts, and it sparked my desire to get involved—that is the essence. In 2018, I decided that I would donate one month of my time every year toward global health. I think donating money is easy, and I did not want to do that. Donating time is more challenging yet more rewarding. I started looking for options and found the Canadian Anesthesia Society International Education Fund. So many global health volunteer options are available; we just need to look.

During my global health endeavors, I have met many new people, made many new friends, and seen a different way of life. I think I learned more than I taught! I learned how to provide anesthesia when supplies were sometimes unavailable. Choosing between absolute sterility and reusing the sparingly available supplies was probably the hardest task during this journey. In Canada, we take the availability of disposable single-use equipment and drugs for granted.

The best part of the work has been teaching regional anesthesia to very enthusiastic residents who couldn’t wait to practice their skills (sometimes on a patient and at other times on a pumpkin). The nadir, however, was not in my global health efforts but when I returned. With new eyes, I saw the absolute waste of drugs and equipment in Canada, while surgeries in many parts of the world are canceled because of lack of equipment, drugs, sterile gowns, or absolutely anything. Another downside was staying away from family and friends—I missed my home and its comforts.

What advice would you give others who want to get involved in global health?

It is very rewarding. We are blessed here to have all the equipment and drugs available, so it is challenging to work in underprivileged circumstances. Mentally prepare to work and live in unknown environments with unfamiliar or limited equipment.

Get out of your comfort zone, be aware of your strengths, work on your weakness, and be responsible for what happens in your life.

I did not fundraise for the trip, but I did borrow an ultrasound machine from the manufacturer, and it was so handy. In retrospect, I should have collected money to be able to donate the ultrasound equipment that they needed so much. I felt sorry when I had to bring it back. The other thing I learned was to stop seeing developing countries’ health care with a Canadian eye. Providers in other countries work with extremely limited resources, so who am I to judge? In similar circumstances, would contemporary health care providers be able to provide the same level of care?

As you look forward to the next 10 years in regional anesthesia and pain medicine, what do you see as the most likely growth areas for the specialty? How do you think we will be changing as a specialty?

Until now, we have been dealing with quantity: We want to do as much as possible with limited resources. I think we should aim to focus on quality for the next 10 years.

We also need to think of ourselves as perioperative physicians rather than anesthesiologists. Jerry Cohen, MD, past president of American Society of Anesthesiologists, once said that becoming a perioperative physician is necessary for quality patient care.

Finally, we need to seriously think about our anesthesia practices’ huge amounts of waste and carbon footprint. We need to focus advancements in regional anesthesia and pain medicine on cost effectiveness and reducing our carbon footprint on this planet.

Describe some of the most difficult challenges you have faced in your career and how you overcame them.

Being a female in the profession, especially one of color and visible minority, has been the greatest challenge in my career and continues to be so. The only way I’ve overcome them is by working twice as hard for the same results. Discrimination is a widespread disease that exists in different forms the world over. I have worked in many countries, and I do see some changes, but they are too little and too slow. If women make up 50% of the world, why are they not 50% of professionals?

Describe what you love most about your job and why.

I love to see the smile on the patients’ faces in the recovery room!

Can you share any of your favorite tools for teaching and methods of mentoring?

I teach and mentor by example.

Please share a few sentences on what you think the key factors are in developing a successful professional career in anesthesia.

We must have passion and unlimited curiosity. Developing a successful professional career takes time, patience, and effort. I am delighted when I see an enthused postgraduate year one resident. It gives me so much hope for the future. My advice: Get out of your comfort zone, be aware of your strengths, work on your weakness, and be responsible for what happens in your life.

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