The twin blessings of universal health and education have shaped who I am
Being made a member of the Order of Australia has prompted me to question how I repay a country for improving my life and giving me the opportunity – as a doctor and a writer – to make things better for the next generation
By Ranjana Srivastava
I was born in Australia but my Indian parents returned home when I was a baby so my earliest memories of Australia were really their memories, all of them of a remarkable time shared with good friends, helpful neighbours and dedicated academics. The fond photos they showed me with did not resemble anything in my Indian experience – instead of wide open spaces, quiet landscapes and dazzling blue ocean, I grew up amid the perpetual but mostly happy din of a billion people. Of course, never having attended a barbeque, seen blonde hair or splashed at a pristine beach didn’t diminish the contentment of my Indian childhood but it did give me occasion to wonder what that faraway land called Australia was really like.
My own Australian experience began when I returned here alone after completing high school in the United States with the hopes of studying medicine. The heartache of many rejections followed until an impossibly last-minute interview secured me the final seat in the entering medical class that year. For every student that enters medicine there are nearly 150 applicants, all able, most unlucky. Having brushed against failure, I was doubly appreciative for my lucky break, that too at a university where I studied on the public purse.
When a dear friend quit medical school to save his parents money, I realised that unlike my American and Indian peers, I never had to question if my education was affordable. In fact, I was being paid an allowance called Austudy so I could concentrate more on my studies and work fewer hours at the local bakery. I was on a form of welfare but I never once felt self-conscious, just extraordinarily lucky to be its beneficiary and I pledged to repay every bit of that assistance one day.
In medical school, I once fell quite ill and had no one to look after me but the public hospital had my back. Having witnessed preventable deaths around the world, I was left to marvel that my health and dignity could be restored without paying a cent.
Although I was born in Australia, I consider my experience in many other ways to be that of a typical migrant, straining to find a foothold in a new country, stumbling, recovering and trying again. I lived in shared housing, ate cheap meals, bought second-hand textbooks and relied on the goodness of people I met.
Eventually, I became a doctor and the tide turned. I have now lived most of my life in Australia and have undergone many rites of passage including becoming an oncologist and a writer, marrying a wonderful Irish-Australian husband, raising children and building a life that I could not conceive of elsewhere. I feel multiply blessed but if I were to name the two most significant things that happened to me as an Australian, they would have to be the twin blessings of universal education and universal healthcare. Together, they have shaped who I am, how I think, and what I do.
I am simply helping repay a debt to society for supporting me in my time of need.
How does one repay a country for improving one’s life and one’s chances and therefore the opportunity to make things better for the next generation? This may be a curious question for those born and raised on this soil and never really having entertained the notion that this country’s freedoms may not be simply be their due. But for itinerants like me, who have experienced the alternatives, and for whom life in this country wasn’t ever granted, this is a question imbued with lifelong meaning.
To work in and uphold the public hospital system was a deliberate choice for me. It is where I feel at home and make others, who are as vulnerable as I once was, feel at home. These patients, mostly overwhelmed and grateful, are prone to marvel at the sacrifices doctors and nurses make but I know that by serving them ably and compassionately, I am simply helping repay a debt to society for supporting me in my time of need. Universal healthcare is under strain and it will take all our energies to defend it as a right rather than a privilege.
My residents and fellows must tire of hearing me say that all good medicine is about one thing – advocacy. From the premature baby that fits in our palm to the dying lady whose emaciated hand we hold; from the injured man begging for analgesia to the disabled woman screaming for recognition – they would all be better for our advocacy, and indeed, we would be better for being their advocates. In an era of unprecedented scientific progress, it has never been more important to bring the patient along on the journey. Illnesses don’t happen to organs; they happen to people. Organs don’t remember our deeds, people do.
Something I realised early on, and that surprised me, is the gulf between what patients experience and what doctors think they experience. The pinch of pain, fear, isolation and vulnerability during illness were universal, then why did the public believe doctors to be above such experiences? And what could I do to change it?
Having always written to find my own equilibrium I realised that writing for the public can also provide a way to demystify and hence democratise medicine. The doctor-patient relationship involves two people but sometimes you wouldn’t know it for the power asymmetry inherent in it. Every interaction with a patient contains the unrivalled power and pathos of human drama – and has much to teach us.
A daughter quits her lucrative job to look after her estranged but ailing father. A man employs saintly patience in the care of his dying wife. A sister guards her brother’s bedside because he is mute and scared. A wife compromises her bad hip but honours her husband’s wish to remain at home. Their stories inspire us, move us, and ultimately embolden us to be better versions of ourselves.
Writing for oneself is fulfilling enough but having a public platform from which to engage an audience feels doubly special. When a grandfather in rural Punjab, a young mother in Santiago and a nurse in Brisbane all see a hint of themselves in a column it points to universal themes of humanity and compassion in medicine. A Pakistani schoolgirl from Manchester dreams of becoming a doctor; an Afghan diplomat longs to improve end-of-life care; a Chinese oncologist rues the pitfalls of alternative medicine – only the written word connects us but together we can champion the common cause of a world of patients.
Good medicine isn’t just about the patient before us but all the unseen, forsaken and needy ones too.
Not for nothing is Australia known as the lucky country. Each time I return, I am struck by a sense of gratitude that I live here. I am grateful to the patients who trust me with their health and to all the people who ensure that their sacrosanct stories are portrayed ethically and meaningfully to the world. And rarely a day passes when I don’t celebrate the excellent education that made it all possible.
The refugee issue is roiling around us – if we turn our back to refugees eager to do us proud we all stand diminished. Many university students today lack the requisite financial support and great opportunities that I received and it’s disappointing to note how poorly scientists are funded or respected. Our policymakers would do well to heed Nelson Mandela’s warning that an education is the most powerful weapon you can use to change the world.
The premise of universal healthcare as a right is under threat but as the population ages and groans under the burden of chronic disease, it is more important than ever to cherish and adequately fund the public hospital system and bolster primary health care. Anyone who has ever been treated in the public system knows that despite some inevitable hiccups the majority of patients receive exceptional care, which is why universal healthcare should remain the jewel in our crown.
I am humbled that a country that I came to as an adult has chosen to bestow an honour upon me by making me a member of the Order of Australia when I am the one who owes it the recognition. The real honour, of course, is that it has let me fulfil my dream of becoming a doctor. And then, has paid attention to my writings on being a doctor so that the arm of advocacy might reach beyond the bedsides I visit. For a child who wanted to be a doctor and a writer and didn’t know if either was possible there could be no greater reward.
— Guardian News & Media Ltd
Dr Ranjana Srivastava is an Australian oncologist, a Fulbright scholar and an award-winning author. Her latest book is After Cancer: A Guide to Living Well.
