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Lovely. So, hi, everybody. Welcome to tonight's ST webinar. Thank you so much for joining us. Um This lovely cold October night that is now very dark because the clocks went backwards, which sucks. But thank you for coming. Um We've got a lovely speaker tonight. He's gonna be talking to us about her experiences working abroad in gum. Um My name is Alice. I'm one of the staff education colleagues. Um I've also got a colleague with me today. Aha, if you want to introduce yourself. Hi. Uh I'm one of the dash ambassadors. I'm a final year medical student at the University of Leicester. Perfect. Um And yeah, we're gonna introduce you an NAIA who has got quite an impressive bio. So over to you. Aha. So um luckily we have Doctor Nadia Ahmed with us today to talk about what it's like working abroad as a gum doctor. She's a consultant HIV, and sexual health physician at the M Market Center in London and she's also the medical lead for the HIV, inpatient liaison and the sexual function service. And she's also practiced as a forensic physician at the Havens in London. Um, she enjoys service development having led on the implementation of adolescent youth friendly services, preexposure prophylaxis and school, school health services for adolescents in South Africa and also has extensive undergraduate and postgraduate teaching experience. Um Nadia is passionate about international health and has completed clinical service and educational work in many countries including South Africa, Malawi, Bangladesh, Iran, Turkey and Sudan with organizations including including the Desmond Tutu Health Foundation, GRE and Doctors worldwide. So over to NAA. great. Thank you so much. Um Alice and aha also to um and for those that have joined, um really thank you for, for having, well, having me talk about this. It's something I am very passionate about. Um I'm a consultant now and I've been a consultant for about gosh I CCT in 2015. Um And, you know, just to say when I first started out, even as a medical student going into med school, even premed, you know, med school going through all those applications and so on or just think about what you want to do. And throughout the career, international Health has been something I've always been, you know, wanting to do. And I always remember in my personal statement, I wrote something about, you know, the images that we see on the TV, about humanitarian crises. Um I didn't think it was possible to, I think get where I, what I've managed to do. Um But, you know, people always say, as you go through your career you can do this, you can do that. And I just thought, oh, it's not gonna happen. Um, and it was actually a medical student that was doing a placement with us. Um, who just said, oh, my gosh, you've got, you know, you're doing this, that and the other. And I just, for a second I thought, well, I think I might have reached what I would like to do and there's still, you know, still next stages. But, um, II really wanted to, you know, show you how it is possible. I know you've had talks with, um, and also, you know, some of you might have had experiences with ups abroad. Um, but it, it's really to think about then beyond that. Um, as well. Um, we all do electives, um, you know, ups, some people do in various things at various areas, um, of which I think I know a lot of people go abroad but, you know, in terms of pursuing that after as a consultant and really marrying it with your, with your work. I hope hopefully I can say it is possible and I'll, I'll show you how I've, how I've managed to do it. Um, but also try to consider the other, other ways. I'm very much a clinical, a clinician in terms of, I mainly do clinical. I'm not an academic, I don't do research trials, etcetera. I've got an interest in education on a service development and a lot of it has been fostered, particularly service development by the work I have done abroad and then brought it back. Um So I'm going to be very open and honest um about how I've done it and my experiences, the positives and negatives. Um So please do um ask questions, there's AQ and at the end, but if you know, for example, if you do want to put something in the chat now, so you don't forget it later, please don't be shy. Um do ask. And as I said, I'll be very open and honest. So hopefully, I don't think I'll offend anybody with that level of honesty, but I just really wanted to give you a real um experience because often there are, I think, um you know, sort of notions around working abroad in, in various ways or people have a view of it that haven't worked abroad necessarily. And I think that there were lots of things to consider. Um And I think fair to say a lot of this is personal opinion because everybody's experience is different. Um You know, obviously we can't get randomized control data on, on, on these. So it's, it's all, you know, personalized experience. So, yeah, so it's helpful. So what I'll do is I'll cover a little bit about why, why I chose to work in global health. But also I've tried to think about it objectively in terms of other, you know, positives. And as I say, negatives loosely um How did I get into it um into the scene? Um Besides that interest and passion and just wanting to um my experiences are past, present and future opportunity, the future things I've been working on um positive with the negatives. Um And then also, what are my own learnings from working in, in Global House? A little bit of a few. What, when, where, how high I hope I've covered all of the things that we mentioned I mentioned in the title and then by all means is the questions and answers. I was saying to Alice. Um and I should um before there's some, some pictures, I'm thinking, why on earth did I put that in? So apologies if some of the images um are, are a bit left field, but I genuinely cannot remember why I put a picture of a note here in. Um But there is um I'm sure there's a rationale that I'll think about later on when I'm having dinner. Anyway, bear with those images. Um So why do I work in local health? Um So I I've got a my personal background, I'm um so I'm I was trying to think how to explain it because II vary in how I explain it. But basically, my grandparents are Indian, they moved to South Africa. Um My parents were born and brought up in South Africa and my dad happened to be born in India because his mum was on holiday there at the time. Maybe it's a bit tm, but anyway, there we go. Um, but they both grew up in South Africa and then moved from South Africa to the UK and I was born and brought up here and II do think, I think there's a few, few people that have got, um, personal backgrounds. Um, so I, I've gone to South Africa Main. I've only been to India once when I was a five year old. Um, you know, every summer holiday. Um, so I know South Africa very well and Cape Town, um, in particular, I've got family there. I speak Afrikaans very badly. Um, but I speak it and I think it's just through that, that, you know, there's that side of things and knowing what the healthcare system is like, um, H IVS are really, you know, it, it, it's the country in the world where they've got, you know, the highest numbers. Um, so it, it, it's that sort of, I guess maybe I want to say ingrained in me in terms of wanting to, to do a bit more global health. But having said that that doesn't have to actually have to be anybody's reason there can be other reasons, of course. Um, so I think there's always been that pull or draw to it. Um, there's travel side I've always loved to travel. Um, and my parents have been, you know, very, you know, since I was a child, you know, holidays abroad. Um, but in terms of seeing countries that, um, you know, from every, everywhere, from Syria to, um, European countries. Um, you know, so they, they've always, I think opened mine and my sister's eyes around what's out there in the world and I think that's just, I think fostered my curiosity and interest in global health and you see things obviously as you go through, um, uh, you know, even if it's in AAA developed country or undeveloped country and sorry, that's global north or global south. Um I think, you know, through that, but also generally, there's always been that frustration about inequality. Um And I'll, I'll touch on that a bit later as well. Um uh particularly in South Africa. I know I did my elective there, but also just, you know, as you, some of you may have visited Cape Town. Um although it's very developed, you do see the poverty um that there, there is there and also hear about personal, you know, stories um not just through relatives, but you know, through people that you other people that, you know, um there's that drawing to it. I always say I did when somebody asked me why I did medicine. I don't know. I II think II can give reasons in a textbook way. But often there's a there for me, I think the strongest reason to do something is you just don't know, you just know you want to do it. So there's that there's that outside. Um, which is my next point on slide anyway. Um, and I think, you know, as cheesy as it sounds, but there is a, a real scope to make a difference. Um, I, in a way that I think a lot of us do medicine. Um, so sorry to sound a bit cheesy there. But, yeah. Um, and then, you know, the other thing I wanted to throw in was the reasons that people do work abroad. I think a lot of there's a lot more um uh I guess awareness around academics who do research and trials and so on in global health. But there's the clinical side which I absolutely love educational side and service side. So, and I think through my experiences, it's, it's really enhanced what I have done here in the UK. Um but also, um you know, it's a two way street. So I think what I've done in the UK has helped me with things abroad, but also what I've done abroad has really enhanced um that learning further and I'll, I'll show you through that. And again, I don't know why I've said that I'm a volunteer. Just thank thank no extra thing. I do remember now. Um You know, a lot of the stuff I've done is voluntary. Um And you know, I don't want to say you should be doing everything voluntarily because I think with time you do realize that time is precious and you do need to consider other aspects of it if you, you know, in terms of monetary wise. But I have, I think most of the stuff if not have done is voluntary. But I think, you know, when you do think actually hang on a second, this is a significant amount of work that I'm doing. Um and I II will, you know, be open and honest about when I have have received um or asked. Um So I think sometimes you need to be aware of, not just, you know, putting your hands up all the time. I think that's why I put the image in. Um And you know, I do, I do genuinely out of passion and interest in wanting to make a difference again as cheesy as that might sound. So, you know, just a thank you is more than enough. Um So, yeah. Um So how did I get into the scene? Um So I could ask you and say, what, what am I, what am I trying to say here? II really just want to say, I think I've just been really jammy. Um There's no, there's no um rights or wrongs or ways in which it's happened or um you know, I think posts, I don't think I've ever applied for anything. Um But I'll show you through that journey in terms of official roles. Um But I think it's just asking, looking out for opportunities and I'll, I'll go through that as I mentioned, so I do want to say, I think I've been a bit jammy, um and a bit lucky. So, hence the cat, I was talking to Alice and um uh and earlier about my cats, um and I think everybody who knows me knows I have cats and I just own it now. So we'll feature cats again in this, this talk. Um So yeah, so a bit about that, but I'll, again, as I mentioned, I'll, I'll go into that in a bit more detail. And I think, you know, I've put this image here to say that, you know, it's, you know, it's about creating your own luck, but it's about, you know, if you're interested in something, go for it, if you're passionate about it, go for it. Um do whatever is necessary um within limit obviously. Um But if you've got that interest and, you know, just, I think I just really wanted to say, encourage you to um ask people follow up on it, don't be shy to kind of pester people and just reach out. And I think that's how I did it. I think not in an irritating way to those that I've um done it, but that in the organization I worked with. But also I think shows that you, you do complete stuff, you do, you can get stuff done and, you know, people will then think, think about it, but it just takes time to build it up So, um how did I get into the global se I think in a bit more detail rather than the, the wooly stuff. Um So I do have, I do have dual citizenship, so I've got a British passport and a South African passport and I think just having a South African passport and I'm just saying that out loud, I think that helped with a lot of the South Africa experience that I've got and that's where I think I've spent a bulk of my, um, well, that's where bulk of my experience comes from. Um I'm not saying go out there and get another passport but just, you know, to be full, full transparency that has helped. Um how do I do it? Um So often I think people think that I'm just working all hours, but I will share a little bit of personal stuff as well. But I, you know, I've managed to take it as an amalgamation of annual leave, study leave and then personal leave or pro well, I say personal professional leave rather. Um and it's just, you know, being really, um I think meticulous with that and organized. Um So it's all been done through that. But on the flip side, I would say, you know, last year, I don't want to say I burnt out, but I did a lot of it during my annual leave or took a bit of professional leave and then took annual leave. So this, so what I have done is reflected on that and tried to be a bit stricter to have proper breaks. So it's annual leave. And I think almost this whole year annual leave has been proper annual leave as opposed to, oh, I'll take a bit of professional leave and then a bit of annual leave on top of that. Um So it's a bit of a malation of the three. And then, you know, you know, again, maybe not cheesy, but I think it's just being passionate and enthusiastic about it, asking, reaching out um not being shy. Um, imposter syndrome is increased in it come in loads and I'll give you 11, I'll explain um that in a bit more detail with one of the examples of organization I've worked with. Um And although I've said not ambitious, um just to explain that further, I, you know, I'm not somebody that wants to be, I don't know what the right word is, but um you know, yeah, ambitious, I guess I ii it's more that it's just genuine passion and enthusiasm and I really want to make a difference. Um And you, I think you do have to be very flexible, very easy going with the global health scene. Um You know, you can organize a time for, for, you know, for teaching and, and do something. But, you know, there's timings and there's nuances that we don't fully appreciate. And I'll again explain that as I give you through the examples of when I've done work abroad and not realize stuff and you feel stupid afterwards. So, but it's just about really being flexible, easy going, open eyes, open mind and all of that. Um And then really, I think it's opportunities that have come up through life. And as I said, as I illustrate my, my journey through you, you'll see that and grabbing those opportunities that have then led to, led to other stuff. Um So don't be afraid to ask inquire and follow up with those. Um I remember when I took a first UPI I remember a colleague um who's a consultant at Barts and I don't want to name names as such, but um who was in it, you know, really helpful and supportive. And I thought, oh my gosh, I've reached out to all of these people. And what if I then I wasn't being um what's the word, um egotistical, I guess to think? Oh my gosh, what if they all want me? But I just did have that moment of thinking. It was a bit overwhelming and I thought, well, I don't want to let somebody down because people have responded and said there's potential this or potential that but it, you know, really just cast your net out wide because working abroad also things just fluctuate and change as you're looking at the world at the moment and seeing all the problems going on. So what might be an opportunity then just suddenly goes and then, you know, you'd regret not have got asking about the other opportunity. So don't be afraid to ask, inquire cost, the ne net out wide and follow up with them and the stickler for following up. So there's no harm in, you know, just a reminder or just wanted to follow up on this. Um, so, yeah, so, um, in theory before I get into the practical stuff, so I've, I've always been a, somebody, maybe this is a bit stubborn of me, but I always think practical experience really speaks volumes. Um So, and I think it's really important, but I think often on paper, it's always important to get that, you know, the um uh you know, the qualification in it. So I, as I mentioned, I do a lot of educational stuff as well and I've always shied away from doing an M se um or, you know, post grad um or diploma in education. But I'm gonna, you know, I have to, I have to do something. So I'm putting together a portfolio with F hea. So I do think it, I think it is important to do that, but I always think practice, you know, sorry, it's not, the practice makes perfect, but the experience really speaks volumes. And I think that's really developed me um in my um learning and then backing up with theoretical, you know, well, qualifications, let's say. Um So what I have done and this is only through the years is thought, you know, I've done a course on global health service delivery. Um And that one was with Harvard X. So they do um online courses and it's not, they're not too expensive and I think I did manage to get a bit of funding through um work for that. Um I also then recently did a health economics and policy course and that was really, really helpful as well. I am, as I mentioned, working towards my F hea. Um And then also, you know, in terms of service development, our a service I work at CWL does a lot. They've got a Qi academy so quality improvement sessions um and you know, lectures but also courses that I've attended. And then also there's the Institute for Health, I think it's innovation. I've forgotten what the other I stands for. They did great courses as well that I just did in my own time online. Um to just, you know, there's, they're not formal formal diplomas or anything like that, but they act as a, you know, I've done this course, you know, about just doing it. They were really interesting as well, but helped me consolidate the practical with the behind the scenes and really helped me, understood. So I think some of the frustrations I had when I was abroad. Um And you know, why aren't they doing this or why aren't they doing that? Um So, yeah. Um The other thing in practice is, um and this was one of the slides I thought, why on earth do I put this in? Um And I genuinely cannot remember. I really cannot remember. I've put it in. It's embarrassing. I'm just gonna kind of leave it there and think I will, I will hit on themes. You can see my cats there. But I think, you know, in practice, I II think part of the reason I, I've put this in is because, um, you know, it's the experience that I have, I think developed with um uh you know, sexual health, uh but you know, expertise in sexual health but more so in HIV. So I mainly work in HIV. Um, but over the years as a registrar I did for a couple of years I worked at the havens. So it's having that level of practical experience. Um, and I really don't know why I put the other pictures in as well. But I think, I think this is the reason that II, maybe the reason I put it in Bristol also just show that, you know, there are other things that I have in, have in life and, um, I think in practice trying to do stuff abroad. Um, you know, I'm, I'm at home with, with three cats. My, one of the cats lives with my mum. Um, so I don't have the level of commitment in terms of a partner or or Children, um, that I know can make things a bit more, you know, difficult in terms of doing stuff. But I do have to, you know, make sure my mum can look after the cats and, and so on, but I do do other stuff outside of, um, it as well. So I, I'm gonna embarrassingly move on from that, um, and move on to the, the real, you know, sort of journey that I've done. So I, you know, I went through med school, um I went through my, you know, f one training CMT training and at that point, um I applied for GU medicine and, you know, go into the details about why I did GU medicine because I just want to focus on the international side. But, um when, when, when I, once I'd finished my, um initial training, I was a bit, you know, jaded, not jaded, but I was a bit fed up by, you know, the nights M RCP revising for that. I felt like I just needed a break. I needed to take the time out. And initially, when I, so I managed to not managed to, but at that time, they allowed you to apply for your specialization. Um And then I was allowed to, you were allowed to defer and take an up and it was the first time I'd taken it, I'd taken time out. I'd always gone straight, I'd gone straight through otherwise. Um, so decided to take time out and go to South Africa for a year. Um, I went in a way that I didn't have a job. Um, so I did a bit of locum work before I went, I had to earn a bit more money. Um, and, um, just went there for a bit bit of a break, but with the intention of also trying to get to get work and getting a bit more experience in HIV, although I did have a number, so I was coming back to a secure person. I believe you're not allowed, allowed to do that now. Um And when I was there, um uh I it was difficult to find work. So I had contacted an organization called the Allied African Health Professionals. I think they're called it Allied Health Professionals who had tried to help me find a role um and a job and they were, they did have one, but that was, it was in an area that was um not very rural, but outside of Cape Town. And I had family um in Cape Town. So I was quite, you know, stubborn, maybe if you want to say and restrictive and said, no, I want to stay in Cape Town. Um And you know, it ended up meaning I was there without a job, I could see my bank balance going down. It was a bit stressful. Um And then a family member who was a, well, my uncle who had a friend who was a medic said, you know, somebody who's looking for um a doctor to work at one of the clinics in Mitchell's plain um in Cape Town. And he put me in contact with that doctor. And the other issue was I didn't have a registration in South Africa. Although I had a passport, a South African passport, I didn't have a registration in order to get registration, you need a job offer. Um But in order to get a job offer, I needed registrations. It was a bit of a catch 22 situation. And this doctor um he was from Nigeria originally. He said he's been in the same situation, really lovely guy. In fact, I must reach out to him. It's been years since I've, I've spoken to him. Um and he just said, look, I'll help you out. Um Why didn't you come a volunteer for us? So I volunteered at the clinic. Um and what I was allowed to do is see patients. So this is all above board. Um but I wasn't able to prescribe. So then I would ask the, the colleagues or doctors and, and you know, sort of Deb with them and then the other doctors there too and uh to, to them prescribe and then um he gave me a job offer to get my registration and then they, and by chance a job actually came up there. Um So I applied for that and got it. Um and then got a paid roll and work there and, you know, the salaries are different. It, it's not a massive hit but it is a slight hit. But at least then I had a bit of an income coming through. Um, but, you know, I really, I locum first to sort of support myself financially and then, um, went out there. Um, and I think I initially, I stayed with, I stay with family. I initially stay with family. But yeah, anyway, um, so I then gained really great experience. It was an HIV clinic. This is the team that I worked with. Um I still go and visit them when I can still in touch, in touch with some, some of them. Um So it was, it was really great and it was just an opportunity to, although I was working and saying I wanted a bit of a break. Um, the clinics were a bit, you know, worked in a very different way. Um, there. So we'd see, you know, maybe see about 20 to 30 patients if not more a day. Um, but it was an outpatient setting. I wasn't doing inpatients. There was a bit more control over that. Um And I said initially there was a volunteer was very much dedicated and was there, you know, five days a week. Um, but, um, we'd all muck in and, and help out so that, so that was the initial exposure that I had. Um, and then I came back to the UK and did my um specialization in gender urinary medicine. I then got a, let's say itchy feet again. Um So I took a couple of months um out to do an ep um So there was that initial p prior to specializing and then I did an up during the specialization in both South Africa and in the UK. Um And so I think it was my third year um as a registrar and I thought I was really interested in adolescent health. Um and one of the um I think the areas that we don't really get experiencing in is pediatric HIV. And I just thought it'd be really good to get that full um experience. And you know, yes, there is, there are Piatt cases here but in South Africa there's, there's loads. So I contacted, II can't remember who put me in contact with the person, but it was Karen Michel who is um lead achiever Africa, which is different to Chr UK, completely different. Um And you know, by asking her, she put me in contact with mo archery you can see is in the picture who is a pediatric infectious diseases specialist with HIV interest, but also adolescent interest and obviously pediatrician. Um and then managed to get a placement with his department um and worked with um uh I think it's, yeah, Doctor Kendra who's in, in the picture and then she Pillay who was one of the pediatricians, she's the one with the strike P top. Um So I, you know, was then did I did an EP with them essentially and it was for a couple of months. Um and II also um supported an uh the Africa organization who was come on to the next slide. Um So that really gained y you know, I had further experience and it was a very much a clinical attachment. I wasn't seeing patients, but we'd be sitting in clinic with them. I got help with a few trials. Um and also um you know, sitting in a meetings, ward rounds, et cetera. Um And then I part of that, I also then um came back to the UK and did my havens training um because that needed a bit more dedicated time and then got signed off and then continued that out of hours um doing forensic work for the havens. So, um as I mentioned, so as part of that experience in South Africa and this time I was in Durban, um which is in Kwazulu, Natal. Um I also then worked with Chiv Africa. Um and they, so I did a couple of days at the hospital and then a couple of days with um chiv that's, I think it's classed as an NGO or I can, I don't think it's a charity and they were, they were implementing adolescent youth friendly services. So I helped with that program and that really got me into a bit more education, a bit more programmatic, but also service development. And we went out to very, very rural areas but that then um fostered further work with them when I returned to the UK. So I would go back and forth during annual leave again and go to South Southern Africa to do to run some of their workshops. Um So you are starting to see the dots are connecting. So these were some pictures of the workshops that we did um while I was there for the three months. But also when I went back afterwards, um and that involved education with um uh medical staff. It was nurses, counselors. Um But also we would sit in clinic and support them um for their learning and, and so on. So, um so there was really, you know, sort of bits and pieces of education service development, but also clinic, clinical stuff. So no research. Um And as I said, I think that you can get somebody else to do for talk on that side of things. Um And then, um yeah, I've mentioned various trips to South Africa and Africa and then during my registrar years, um some of you may know Tristan Barber. So he was a registrar colleague at Mortimer Market Center. Um I never, I, I'm really bounded with work but there was one evening when I checked my email after, after five and I'm so glad I did um because he'd emailed and he was involved as no street, which I'll explain a bit more in a second. Um and said, does anybody want to do an exchange ship as a doctor in Iran? And I just immediately me, me, me, me, me pick me, um replied to that and um that then led to um more work with Jos Dry or Jos. So Jos Dry is an organization that's run by Mike. He's an associate specialist at the rule free. Um And uh two of his colleagues, one of them passed away and they were actually of their friends. Um and one of them um still supports the work of Joss Brent and he has become a good friend and Mike, I always remember him saying, um that the reason he did it was because he just wanted to, you know, to help. Um But also the name of it name just, you know, just why not just try, although he's told me differently now as to the name, but I always remember him saying that. Um so what I then did was, um initially we got the doctor over Ihsan who's um sorry, I don't know if you can see my mouth but he's the in the top left picture. Um I'm, I'm there with the hijab. Um I was in Iran so you, you do have to, to, to dress, dress conservatively, but he's in the white shirt next to me. So that's it. Um Ian, so he came over initially and we hosted him here. Um So I supported that and you can see in the bottom left you go, you see Tristan there, we went out for dinner and Ian Williams, um who's a retired colleague now, um an amazing retired colleague. Um So we, he supported, so he supported me in supporting Ian here because I was a rich doctor at the time. So Ian came over and spent a couple, I think it was a week or two with us um in the service at, at Mortimer market um center at the royal free to, to see how we ran things and how we did things. And then I went over to Iran. It took quite a few years for me to get, get there because I think if I hadn't fully appreciated what, you know, that it was an exchange program. But then also there were very, there were a lot of restrictions with me trying to get to Iran and timing had to be right and the support there because there was a lot of suspicion as to why would somebody be interested in coming to see um what we are doing with HIV. But there, there's also a lot of I think hidden information um as well. Um So when I eventually went over, it took a couple of years and as I said, you know, initially follow up, pursue it finally happened. And when the opportunity came, we, I went because as, you know, look at the world now and how volatile it is. So when these opportunities come up and another piece of advice is just go for it. Um, so I went out there and, um, you know, spent some time with a sign in the infectious diseases unit there. Um, he does clinic in the evening. He used to do clinics in the evenings as well for IM so attended there and then the picture in the top right corner and II, am so sorry, I've forgotten his name, but he was the physician that looked after the HIV patients in the specific HIV clinic. Um, I mean, I, there's a whole talk on HIV and Iran itself, but he was amazing. I mean, he, he worked 24 7 when he was on leave. I said to him, what do you do when you're on leave? And he said, oh, it's fine. The doctor, if they need me, they'll call me. He would go knock, knock on the doors of patients. He hadn't seen, they said lost to follow up pathway. So a really amazing clinician. Um, you can see a picture of me with a load of females and those, those are laboratory staff, the I team and they also asked me to do a talk on respiratory disease and HIV as well. So I spent, you know, a good few days there and it was just such an honor to have been to have experienced that. Um But I think the key is really go when you can and, you know, still very much in contact with Isan and his family who were wonderful and also had the opportunity to stay on to see the rest of Iran. Um So these are just some of the pictures I phoned in. Um So, uh you know, the clinic that he was at the hospitals, he took the pictures for me because, you know, they, they, they look, you know, I say restrictions but um I think it was better coming from him to have done that. Um And I think one of the big learning things from this was, um, you know, I brought him over had this time for him. It was quite intense and he was quite tired at the end of the day. But when I experienced how he worked, what they tend to do is work in the morning. They have a bit of a siesta in the afternoon and then work in the evening and I felt so embarrassed and so silly, but, you know, he was lovely and very much like, no, no, you know, it's how you work. Um But you know, it, I think it, you know, on reflection, it's about making sure, you know, you check, you know, you check in with them is this, would this be suitable for? I mean, obviously I did check in with them, but I think there's that side to say you know, what is your working pattern? How does that work? Do you, do you want to do that? But equally, you know, there, there is a side, there's only so much that we can do because not everything that we do is in the clinic and um given the short period of time he was there, but always important to consider those things as well. Um I could talk, I mean, for, for another hour on Iran, but I won't obviously. Um So, and the next thing that happened was um so II then CTD and um I was in that um ct phase where you were looking for jobs, there was a potential job coming up more to the market, but it was slightly in the air. Um And this opportunity came up in South Africa um through a colleague that I knew um some of you might know Rebecca Marcus who works at the consultant in the north mid and she had done, I think a new p in South Africa and was working at the Desmond tutu Foundation just headed up by Linda Gel Becker who was the past, past, past, past president of the International Aid Society. Um So she, she was leaving and she said, look, they're looking for somebody. Would you be interested? And she, I think she knew of my South African background as well, got a passport that makes it easier. Um uh in terms of, you know, sort of visa requirements and so on. So I approached um Linda Gel Becker, I think it was on holiday at the time and we, we spoke and then initially things were a bit, oh, is it going to happen? Is it not going to happen? But eventually, um it, it was, you know, they um it was confirmed. So there was a bit of a time when I thought, oh, what do I do? Um There was an opportunity at more to market or do I go to South Africa? And then eventually that um yeah, I mean, it, I PCE the South Africa option and I went for you with all of all of that debacle that happened. Um And what I was employed to do was I was an adolescent clinical lead. It, it's an NGO plus an academic center. Um but uh it was a bit of a wooly, I wasn't clear what, what was going to happen and I did try and get them to um to commit to that. But um eventually that enabled me to foster a um a clear pathway. Uh We will actually maybe say what I wanted to do, but also give me a bit of creative um creativity in what I did and also take opportunities as and when and as I got there, things just came flying in. Um So I really feel like this is where I got a really significant amount of experience and I went out there thinking I could have been there for forever. Um, and I was there for just under three years. Um, so I did clinical, um, work. So II said I did say it as one requirement that I had to remain in clinical cos I really loved in clinic cos I did a weekly adolescent HIV clinic only saw a adolescents. Um, obviously I'm an adult physician and it got to a point where I didn't want to see adults in fact. But um or oh, I don't want to see an adult. Um but you know, anyway, so main all the adolescents I would see. Um but we would chip in within the clinic. Um, you know, and sometimes it would be up to 20 to 30 adolescents on a weekly basis. Um I did get involved with, with a bit of research and that was one thing, one of the aims I wanted to get more experience in and, you know, from my own, I just, you know, realized that, that, well, not realized that confirmed that that that wasn't the right thing for me. Um We did community projects, there's lots of service development. So it was implementation of prep that was happening. Um youth friendly services, school health services and that was always the department of health, but also um the Global fund who was supporting that further. And my educational experience really stepped up there. So I was course convener for a short course in adolescent health um with the London School, but also in the University of Cape Town um and had great support with somebody who is very experienced in adolescent health, but also adolescent, but also education. You. Um uh so we were around that for three years. Um And, and also so, so much other stuff, I mean, I ended up having to lead on security, which was a bit of a what on earth II, but equally, I think you grabbed those opportunities and it, you know, it enabled my personal professional development. Um you know, in terms of sharing leadership. Um and just, I guess thinking really outside of the box. So some pictures, this was um the, the picture of people sitting down is of us of the co one of, I can't remember which co was the 1st, 2nd or third. I think it was the second group of the short course participants. Um the badges in the corner. So when I, when we did the Youth Friendly Services, unfortunately, the the National Department of Health lost interest. Um II really will not bore you with what happened there, but they didn't conclude what was happening that they had an accreditation process. I took off my own back to design a badge and we had a little ceremony for, for the services and gave them these badges to say that you're Youth Friendly Service certified according to us um that it's just a picture of the team and then um in the top right corner I also delved into and supported some medical students there who have done some amazing work were setting up a clinic for refugees and they needed a doctor there on a, on a weekend. So I used to support them and two of them are now, I mean, two of them are very interested in sexual reproductive health and one of them is over here doing mm se and one of them is coming over next year to, to, to work. Um And then in the bottom corner, real honor to Met Timothy Brown, the Berlin patient who since passed. Um but that was just an opportunity that came up. Um And those are some of the clinic, clinic colleagues. So um to show you that um some other images. So um some of you may know Peter P too was actually I think they said the father of Ebola. I don't know how big he was but really lovely man. Um But we we and his, his wife who's a real advocate for HPV um vaccination. Um and some other colleagues and then on the right hand side, the other image is with Linda Go Beer, but also the amazing nurses I worked with and I really worked very closely with them and they were the ones that really were instrumental in the, in the implementation of the, the services that we did um and still in touch with them. And whenever I go to South Africa and meet up for dinner with them as well. So I had a really wonderful team so I line managed them. Um So I really gained lots of experience in terms of line management. Um And there were a lot really, I mean, so much of that happened, so lots of experience there. And I think one of the key things that I wanted to say with that is um you know, it was not just clinical um educational other things, but there's all those other side of developments, line management. Um There were a lot of discipline that happened, not with the nurses I worked with, but people they then line managed. Um So you really, I think the experience that um of nonclinical staff really for me stepped up um then got um doctors worldwide. So while I was in South Africa, um the ID reg that I'd worked with at the north mid when I was doing my registrar years, um uh contacted um he's a trustee for doctors worldwide. And um I think I knew I was in South Africa and they were looking for somebody to do some work for them in Malawi. So I got contacted by them to say, would you come and do some um a couple of days with us in Malawi, do some teaching and some service um reviews. And that then led on to um other opportunities with doctors worldwide, which has included um two trips now to Bangladesh um to support implementation of their um uh they've got a postgraduate fellowship in refugee health. So I go out as a specialist um and support the HIV and sexual health teaching as well as gender based violence. And they, they also support doctors in clinic. Um They brought me into supporting some COVID checklists um that they have done put together. Um We've also done some training virtually with Pakistan and Nepal to support that COVID um implementation at the beginning stage of the pandemic. Um And then also they roped me into um leading on the infectious diseases module for that postgraduate fellowship um in terms of um revamp not revamping but um uh reviewing all the material and this was something. So all of this stuff has been voluntary, they will support flights and accommodation and there's a bit of a stipend. But um basically that was one piece of work that was massive. And I actually said at this point, you know, I do, do you feel would it be possible to get a bit of um financial support with it? So it's all in my own time outside of work that I would do that? And it really was a significant amount of work. Um So just to show you some pictures. So I'm looking at time and I think, sorry, I'm waffling on. So I'm going to speed up a little, we will speed up. Um The, yeah, so these are some of the pictures, I mean, the Malai experience, this is I've never seen something so ruled a doctor under a tree doing a consultation, plastic table and chair. Um, this is how rural it was and it really opens your eyes to what goes on, you know, goes on that there. But also gets you thinking about, you know, service development, how things can improve and then just some pictures of the team and the teaching we did. So, you know, the practicalities were that, you know, the lights went out at some point or there's power, you know, power failure. So you have to think on, you know, you have to prepare for those scenarios. You know, if your powerpoint slides just suddenly go, what do you do? So you need to, you need to be thinking ahead in that sense. Um You know, it's just a picture of a meeting that attended. These are some of the pictures of Bangladesh. Um So all the doctors that I worked with and I think this was, this was all from the first, no, some of this story, sorry, the second trip was what masks on from COVID. But what was a real pleasure is I then ended up meeting some of those doctors when I went out again. Um These are some of the pictures of the Rohingya camps where we were in. Um As far as the eye can see is how big the camps were and I think the reason I say this is that it really does open your eyes to the inequalities out there. And you know, it, it's, it's difficult when you, you do come back and again, more pictures of the, the Rohingya camps. Um and what, what people are experiencing, living through. Um uh And again, this was the second trip that I did out there and II put this in because, you know, the conditions that they, they work in, this is one of the doctors in the Blue blue um waistcoat. Um And it's not just, you know, to say we need to be grateful for what we have and the support and the resources we have, this was really a makeshift 10, it was boiling in there, it was storming. Um And they, they work in these clinics on a daily basis. Um and doing an amazing job and I think II put this in there because sometimes people will say, oh, it's great that you're doing this and great that you're doing that. I'm going out and supporting these doctors who are doing an awesome job. So it's really credit to them and um you know, a cured us to them. Um The work by doctors worldwide, this postgraduate fellowship got recognized by the United Nations Sustainable Development Goals. So what they then did was um try, they're trying to, they're packaging um this so that the Bangladesh trip was actually very much a pilot phase of this and got recognized by the United Nations. And so the reason I got involved with the, the module review was because they then wanted to put a package together that could be translated to other countries. So it's, you know, taking away the Bangladesh specifics but putting in slides to um uh to be adapted essentially. Um And these are just some of the colleagues in the 2nd, 2nd trip um that I did when I was out there. Um These are the checklist. So I um put these help, put these together, you can access them online if anybody is interested in having a look. Um And I'm very proud of the little diagrams I've put together there. Um And then I think this is, yeah, I hope I'm going on to more reflective bits. Sorry, I'm just so conscious of time because I've been waffling on. Um Yeah, so I'll, I'm gonna not quite skip over these, but I'll just briefly talk to these. So um Jory, I mentioned um before with the Iran trip, but since then, um I've supported quite a few trips with um them and they do quite a few recurrent trips to Turkey where they're doing trying to do a prep roll out. Um But also they run a research toolkit training um for Turkey and uh that was done again in Turkey and Romania. Um And there's been some peripheral support, but that hasn't taken off ST services in Croatia. Um there's also been um so with Beaver, um I've been involved with the international um partner working group. Um So I've been involved with that um loosely um mainly through we, we set up a webinar um in Nigeria, in Nigeria with a adolescent health. And then um I think the other big area that I wanted to mention was inter agency working group. So this is an organization that focuses on reproductive health um in humanitarian settings. Um And this is just an example of I II can't remember exactly how I found it, but I think I found it online, but also a colleague um that I've met in South Africa recommended it. I just reached out to them and I said, your work sounds amazing. How could I get involved um And joined the group very much imposter syndrome because they are colleagues that work in save the Children, uh save, save the Children, you know, U and F pa wh o that level of organization. And I'd go along saying hi, I'm Nadia, I'm from the NHS and I'm really passionate about this area. Um How can I help? How can I help? And um subsequently, I then they were looking for a volunteer to co-chair one of the working groups. And I thought, oh, great, why not did that? Um and had become co chair and, and actually, unfortunately, the funding situation globally um has is really dire. Um And that, that colleague, I coa with who's in a paid role, had to be um made redundant. And they've, I, I'm now continuing that solo um as chair. So it's been really going back to the Jammy Jar Jam Jar Picture Jammy as to how that's happened. Um And that's led to wonderful opportunities with um the wh NF pa um looking at a sexual reproductive health curriculum in humanitarian settings. So I've been, it's more reviewing of materials, but there are major work teams. So I just want to say I'm not doing that full time at all, but it's occasional inputs here and there. Um But also um yeah, some, you know, reviews of wh O material. Uh Again, I do this all in my own time but it might sound like, oh my gosh, how do you have time to do anything else? But it really comes, you know, maybe once a year every couple of months uh and so on. So, yeah, um some pictures. So this is the jos team. This is some, the prep rollout teaching we did in Turkey, II just, just to stress that I felt comfortable doing that. There are many work work in HIV because of the experience I had in South Africa with prep implementation. So this was service development, but I it's really key to pull in other experts. So I've got colleagues who talked to prep to, to do that side, but I felt comfortable with doing the um service implementation side of things having done that in South Africa practically. So I think it's, it's crucial to also know your limits. Um Again, just more pictures from the Romania trip um where we did teaching on um research um toolkits. Um And that was about putting abstracts together, not running trials, which I mentioned of research and press. Um And then I think finally is the if, if she, so the International Foundation for Sexual Health Education. Um So this has been set up um via Luciana Rubenstein as a consultant at Hillingdon. Um And she contacted me while I was in South Africa um to support this and, and vice chair for that. I I'm not going to bore you fully with those details. But since then, we've, we've set up a group. Um we were in, we were in talks with bash about um furthering this work, but, and, but subsequently connected with the International League of Dermatological Society um Society. Um And we had our inaugural course in Sudan um with Bash support originally um last year. Um And these are some of the pictures of the team that went out there. Um But unfortunately, um some of I'm sure you know that there's been subsequently, you know, such a significant war that's been going on there with the humanitarian crisis. So, unfortunately, we haven't been able to continue that work, but I've remained in contact and in support of the Sudanese IV organization that's led by Bushra who's in the picture there. He's a consultant in Bournemouth and Russia who's I think the treasurer, a consultant in Ham. So I, I've managed to continue some work with them in the interest of time. I won't go, go through all of that in detail. Um But that was a phenomenal experience and we're continuing that work. These are some of the pictures of the teaching that we did when we were out there. Um And subsequently, as I said, we're now, um we have joined with the LDS and we've got a project planned in Tanzania, um which will hopefully, um yeah, which we're going, hopefully going to do the first visit in um January and that will lead to, to further things. Um It's 50. Yeah. So it's 752. I'm gonna in the last couple of minutes and there will be time for time for questions. Um I just want to really reflect on all of that because there's a lot of, of, you know, thrown in. So, and I think it's really important for the reflection point. So for your, you know, what's practical for you to think about. So the positive for me, I really enjoy, it really opens your eyes sometimes in a very, you know, negative difficult way and I think sometimes it is that reality check, you know, hashtag first world problems, but you, you know, it's a bit a bit of reality check. Um I always think make a difference. Even if it's one person that you can support or change, not, it's not about changing them. But if it can, you know, if it sees something in somebody and helps somebody that, that's, that's why, you know, it's important again, helping others, clinicians, staff. Um, but also patients and you have to be very careful with what, you know, advice you give because a lot of the work I've done has been, um, more supervisory or supportive, except in South Africa because I've got a license there. Um So you do have to work within your boundaries. Um But equally, you know, if you're seeing something dangerous, I think it, it, it, it would be immoral or, you know, unethical not to say something and, and it's rare that that has ever, it's never happened but, you know, um to consider, um you've just been, you know, there's a need, sorry, there has been a need and want and people are hungry for the support. You know, often I think there's that concern of coming across as being a, you know, British or colonial. But, you know, anywhere I've gone, they've been ever so grateful, really wanted to really interesting in it. And there's so much cross learning, I've learned oodles and oodles and I think that as I said, that South African experience really. But seeing how things run and I think, you know, put some images up here of the mental health services and one of the Rohingya camps, they've done amazing work. And I just thought, gosh, I look at our s some, you know, services wherever. Um And I think there's so much we can learn from, from colleagues and you try and take those snippets back. Um I say the negatives in inverted commas is that it really does open your eyes to the horrors that are out there. Um There are times when you completely feel helpless with, with things that you come across. Um Do you need to have boundaries? You know, the poverty that is there is shocking, you know, I wanted to take out a suitcase of clothing that I had, but I, you know, was told we need to be bounded without, you know, you can't just give it to one person. What about everybody else? Um You know, and particularly with the limitations in access to health care, et cetera, et cetera, um It can be difficult to change things and II don't mean to say we're going out there to change, but the key is really working with people there. Um And I think sustainability. So, although I've done various bits in different countries, I've gone back and continued, you know, things that, you know, Turkey has been continuous. Um Sudan, we were hoping to, but obviously that that still has fallen through because of the war. Um and Tanzania like a sustainable option. So I think sustainability is really key. It's not about doing these one stop visits Iran over the years, I've constantly tried to kind of continue but its funding is very difficult to get to try and support that, but also trying to do it in a, in a way that would be sustainable. So um if so stays in contact, ask for advice. He's, he's connected with other colleagues. So I really a stick for that. Um But there are so many limitations with that. Um You know, returning to the NHS practice can be very frustrating. Um And I've been asked, you know, how do you deal with that? But I think you just have to think it's relative to the situation that I have here. Um And it's about what I am practicing here, so I try and take that away. Um But yeah, there are times when I reflect in my own time about, about that, um the differences of opinions within countries that are socioculturally religious and legally sensitive can be, you know, difficult to, to swallow sometimes because, you know, you want to try and support and advocate but you know, there's, there's so many so navigating that can be a challenge but you, you really have to be professional in those sense, but challenge it in a sensitive way in conjunction with people that in that country and you'll see most people do want to, but you do it in a supportive way. Um Differences of opinions with other volunteers can happen that has happened where I've, I've said, you know, I think we need to try and um challenge um gently gender based violence, for example, approaches to that. Um And in those situations, other colleagues have said differently. So I've gone to the, the organization to say, what are your thoughts? And they said no, well, we do want to try and advocate for that. So because if you've seen wrongs, if you, it's not about writing them in a, you have to do this way, but there are sensitive ways that you can support it. Um But again, it, if it's, it's opinion of a colleague that's outside of that setting, that makes it a little bit more difficult. So I think it's always about, you know, bringing it back, reflecting on it and, and speaking to the organization you're working with and there can be a, you know, a dark side, as I mentioned, touched on moral, morally, ethically and legally II, I'm conscious of time, but I, so I think I'm almost there. Um just a couple more slides and then question. So I think the other positives for me, sorry, you can see an image of food and it's covered. Um the slide that I had um so positives for me. Um are, you know, other, other positives I wanted to just, you know, home into again is about, you know, being in a of the humanity that's out there. I mentioned the doctors that are already out there the nurses, the counselors who are doing, you know, work in conditions that I think, you know, we would just not say we're going to work in, um, you know, walking through floods of water or mud to try and get to clinic still with a smile on their face, traveling for two or three hours a day to get to the clinic and then home again, um the support that you can give the sustainability, you know, in terms of education and service um that continued support on return. And also, you know, being able to challenge things. But, you know, and I can give anecdotes if, if some, if interest in time in question and answers. But I think we, we need to try and do that bit again, really sensitively very gently and in conjunction with colleagues that work in those countries and getting that, that, that nod from colleagues and, and seeing them do it. And when I was in Sudan, particularly um the the Sudanese colleagues who are, you know, work here, they really challenge things. And I think that, that, you know, I'd look at them to say, can, you know, and they'd be like no, go for it, go for it. Um because there are certain things that, you know, are I say wrong in inverted commas. And you know, there's that experience of a different culture um food landscape. Although um and the other thing for me is that I love airplane food. So traveling and I'm happy with airplane foods, um other negatives, I think just thinking about it overall objectively, you know, there's the travel aspects you may need to antimalarials, um flight issues, um you know, delayed flights, flight phobias, et cetera, traveling and living with colleagues, I say living but you know, there can be taxing or, or um uh difficult times with that. But I think generally everybody I've traveled with this has been, you know, easy going. So hence going back to that original thing about being very flexible and easy going, getting on. Well, while abroad, I had a really bad cold once or twice while I was abroad and, you know, you just want to be home in your own bed, but you just have to put up with it and live with it. Um So being prepared, um I can't remember why I've put communication in, but anyway, I've put it in there. So I think communication comes in everywhere, uncertainties of situations, the COVID pandemic, I had to do quarantine before and after the B1 of the Bangladesh trips, experiencing a half, just doing the quarantine alone, but also conflicts with the Sudan experience. We were really excited once we did the trip, but then conflict arose and we weren't able to go back um with really big plans, but that, that hampered it, you know, the short term and long term um of it all. Um and having making sure you've got support in place back home. All of these trips I've done have been short term ones except South Africa and as it for a couple of years and as I said, amazing mum and dad who, who look after my cat babies for me, um, working with different agencies. So you need to navigate that, you know, the different agencies work in different way. I've never done work with, with MSF and MSF are a wonderful organization. Um But I, you know, I have heard that they are a bit more guideline focused and a bit more restrictive whereas doctors worldwide have allowed me to be more creative. Um I did apply for MSF and got through. But then with those jobs, the restrictions can be that you have to be there for a year and I didn't want to do that at that time. Um or, you know, yeah, for various reasons and it, and it is a lot of work. It can be a lot of work at times. Um I've just put this in again again. It's one of the slides I think I can't remember why, but I think it was really to just show that, you know, you mentioned, you know, somebody might be thinking, oh my gosh, how does she do this? I'm very bounded. I, you know, I try and draw when I can. Um I have got the three cats. But so again, just to say that, you know, although yes, I don't have kids and, or a partner. So I've got a bit more flexibility with the travels. Um Thanks to my mum who there is a picture but it's covered at the moment. She looks after the cat. So I'm away. Um So I just want to shout out to her that with that support. Sorry. It's gonna sound like I've a cat crazy here. But one of the cats I did bring over from South Africa. Um, it was the Ginger one there. Um And then also as a slight side joke, I think sometimes the reason I do international work is I'm a big Backstreet Boys fan and I've always wanted to meet them. I hoping one day we will lead to that. But and now you're probably thinking what is she on about um what my own loan is from working Global Health. So I think this is my final slide. Think about why you're doing it. That's what I would really say. Why are you doing it? Um You know, I've put a picture there, there's a Instagram page on uh I think it's Barbie in different settings and it, it's not just, it's not just it's not all about the the pictures to post um or uh you know, oh, I've done this teaching or I've done this. Uh you know, some people get their hit from that and then this is me being very honest. Um It's not about the selfie with um you know, uh patients or colleagues, I mean, sorry, not patients but kids that you may see that I think people often post and, and sorry to say that. But I think we, we really do need to think about our motivations when you're working in global. So think about the academic side. Could it be educational clinical service? Um What do you want to do? And what can you bring um who are, you know, who are you in terms of, you know, what are your interests, what are your passions? Um and other aspects that may, may throw. And I've given you a bit about my personal background and in that sense, how are you going to do it? Um So it's ok again to spread the, you know, your, your net out wide um to get the experience and then decide and focus um linking in with local locals that cannot stress enough. Um And, you know, colleagues that are maybe of backgrounds of the countries that you want to work in. Not maybe, but of of the backgrounds of the countries that you want to work with. It is crucial as well. Um And when are you going to do it, you know, short term can be a little bit more difficult and a lot of places don't offer that. But some of the, you know, for the organizations I, I've kind of found my way through do the short term ones versus long term, which can be difficult in other ways. Um And then think about the, you know, the social culture, religious and legal barriers, which can be challenging. But, you know, you think about challenging that as well in a sensitive way. Um Finally, um you know, I think, you know, it's just, this is really just to say, you know, I think you need to be somebody that's flexible, easy going. Um You know, we're all respectful but I think it's just being interested in different cultures and learning about that and just being sensitive to it. Um You know, you just have to be open to, you know, what could happen when you are abroad. And I think I've mentioned that throughout the through various bits in the talk. So apologies have run over by three minutes. Um But if there are, I, I'm assuming if there's any questions that people want to stay um go go through that. So apologies, but hopefully that was, that was useful and interesting for you and, and I have been very, very honest at some points. Um But I, you know, I think with, with working abroad um there is there is that side that you need to, to really think about. I've held back on some anecdotes for, for further illustration to highlight what I've said. But happy to take questions now. Yeah, with this time. Yeah. So if anyone's got any questions, just pop them in the chat and there's also a feedback link in there too. Um Thank you so much Nadia for that. That was absolutely insane. I know my mind is blown by the amount that you've achieved over the past few years. Um I know you kept saying you might think that how do I do it? But do you work full time? I Yeah, so I II just forgot to say so I do work full time. Um But it, it seems like that's all of people say that, you know, the other thing is people always say, well, you always travel, always doing this. It, it's all clever planning with annual leave, professional leave, study leave. Um But I do have to do stuff obviously out of hours if there's lecture prep and so on and you know this, yeah, but it also comes in waves. Um So it, it's, you know, the doctors, doctors worldwide, I haven't done work with them for over a year now. Um And then, you know, when I went to Bangladesh, it was, you know, I think it was the first trip was two weeks, two weeks of annual leave. And then the other trip was about, I think 4 to 6 weeks and I really managed to push together, take a bit of extra leave, professional leave, thrown in bank holidays were thrown in there. So um the, the prep time is, you know, lecture preparation and then you can do prep while you're out there as an example. Um, you know, with Sudan that was, there were, there were more than 11 of us, so I would be tasked with certain lectures and then you go out there. Um, and, you know, after a while I've got, I've got a whole pool now of lectures where I can bring it together. Um, the interagency working group that I mentioned. So because I'm, I'm a volunteer with that. Um, and there was somebody paid, it's her doing the main work, but I can, I'll meet with her to discuss ideas and so on and, and the, you know, the reviews that I've done um for some of their documentation, it, you know, it's maybe two or three times a year. So, although it seems like so much it, it's, it's a spattering but I think recently I've been learning to say no. So, so I think over the years I've narrowed stuff down. Um So I, I'm stepping away from some things or will be so chiva Africa, for example, I, you know, stopped that many years ago, not doing that at all. Um And there's one or yeah, so, so, you know, you, you really start narrowing down and focusing in, in, on things and, you know, there's other stuff I don't, don't want to say which organizations, but there's some that I I'm gonna step back further with because of, you know, for, for various, you know, reasons. Um But yeah, so you, you do manage to you find me on most weekends just watching a lot of Netflix. So, so it, it's really about being bound but also, you know, just making sure you do have to have those times and that break. But, and working collaboratively, I'm not doing all of this alone. So just, just to be clear on that, you know, you, you, you're being supported by colleagues um you know, uh that they are also out there doing, doing similar work. That's great. Um So there's no questions in the chat at the moment. Um a do you have any questions at all? Um I was just thinking about how political tensions in some of the countries that you've worked in are very high. Yeah. Uh for example, like Sudan, yes. And um even in South Africa, I can imagine sometimes you encounter difficulties. Um Are you aware of that when you're working? Does it, how does that impact the patients that you see? And what kind of steps do you take to ensure, not just um your team safety but your own safety? Great. So I think it's a really, really good question. So I think um to answer that, so I didn't, I didn't say it but as so as you were asking, so I came back the reason I, and I'm saying this because I think partly answers your questions. So in South Africa, um crime rate is higher. But I think for, you know, there there isn't sort of the situation that's happening in Sudan there. But I think the challenges that I faced in South Africa and it was part of the reason I actually came back and I'm gonna be really honest here is that, um you know, there's a big backdrop of apartheid there. My parents grew up during apartheid as well and um I, I'm trying to think about how to put this in a politically correct way. But um there, there are a lot of um let's say politics that happen in, in multiple levels. So I, you know, I did work at, with the NGO the academic center, but with the Department of Health was privy to meetings in with the Department of Health. And then you had a lot of International Funders Global Fund were there and you really see, it really opens your eyes to some of the bureaucracy. I think that's the word that I was looking for. Um and um motivations I want to say of people, egos of people. And after, you know, a lot of similar patterns happening, um it, it was very frustrating and I tried to tried to call that stuff that happened. Um this is not with the organization I work with just to be clear, but in different, you know, different ways, you know, I mentioned when we were implementing the Health Services, um the National Department of Health just decided to drop that whole process, which was very frustrating with no communication. Maybe that was why I put communication on one of the slides. But, um, with no communication and I thought, you know, what we've worked with, with these teams on the ground and they've just now been dropped. And I thought, well, let's, let's close it ourselves. Give them a, a ceremony, give them certificates, give them a badge. So it, it's really, it is, there's no easy answer but it's really difficult. But I think multiple, multiple things led to me, but also for personal reasons, I decided to, to come back um with Sudan. Um So at the time when we were there, there were no um concerns in terms of practical safeties given what's going on there now. Um But the, the key is really making sure you're linked in with people who know the country. So we had Russia Pha um and also um Bushra who were Sudanese colleagues who are in the UK specialized in, you know, g Union medicine. But also they very much would they were the, you know, the link to the Pseudane scholars on the ground. So I think that that's really crucial. I've never worked in acute humanitarian situations, but it's always been the aftermath. So, you know, with doctors worldwide, you are working in a Rohingya camp and, and that's relatively safe, but we do go in with a driver. Um you know, there were, there was some concern at some point with gangs, I think and and concerns around there. But I think it's safe safety measures you would do if you want you, you know, stay on holiday. But, you know, don't go into these areas at night. But also the organizations that I've gone with have got very clear um guidance around safety procedures and protocols and I will advise you on that. Um So there, there's that side of things. The other thing just I think just comment on is around the, the political side of the frustrations you see with that. And um II in South Africa particularly, it was a challenge to, to sort of, for me particularly to, I think, to bring it up. But I think that was part of my own personal and professional development. Um And since then has supported me in sort of trying not calling out things, but I think addressing things because you don't really get to the bottom of it or try and solve it. Um And um it, it, it's frustrating. It is, it is really difficult but you have to be very sensitive. Um I think in South Africa it was a bit easier because I've got a South African background so I could pull that card. Um not pull that card, but I, you know, appreciate that my parents grew up to apart et cetera, et cetera. Um And I think the other thing to say about you, your question is that, you know, we're not going to the countries blindly and I think sometimes it is that concern, you know, you're going to come across like that. You do need to be, do your own homework about the legalities about the cultural, um, side of things, the religious side of things, you know, something is basically saying, you know, do I need to dress a bit more conservatively? Do I need to wear a hr do I need to cover up? Would they accept if I wore a skirt or a dress or, you know, short sleeves or whatever it is just those things and asking so that you are already thinking ahead. But also then thinking about the legalities of the political situation, but doing your own research, but then also checking in with colleagues around that to just make it safe as possible. So I do have that fully answered your question, but I think there's no easy answer. Um I would say, but, you know, doing your own homework, checking in with colleagues um either on the ground or who are from those countries in this, in this country and doing that work with them and also the organization. So I've never gone in so low, but it's always with um within an organization. So they have very strict guidance of making sure you're sticking to that as well. So I'm just going to combine two questions. So first of all, have language barriers been an issue and second of all, um somebody thank you for sharing so much about your honesty and you've mentioned the boundaries multiple times it's cleared and not career wise. And do you have any specific advice to share about keeping yourself sane and happy while doing so much? All right. Ok. So um so language barriers and their advice about keeping yourself and happy. So language barriers so never been an issue. I think in Bangladesh, it's slightly because the patients would speak Rohingya. Um And but the Bangladesh doctor, so the Bangladesh doctors were able to converse with them. So although we would support, we would actually sit in with them and support them because a lot of the doctors who are very um sorry to use the word. But junior um either, you know, first year outside of med school. Um so we would rely on them to translate. So sometimes there were would be things that would be missing. Um But I think this comes back to what I was saying is know your own limitations. So if somebody asked me to do um a talk on um uh II, can't, I'm trying to think of an example. Now, uh let's say warts, OK, fine. I'm a ge physician. I could do it. But II know I would, there would be a colleague that would be better placed to do it. So I would actually refuse to do it. So I think the same, same goes for language if you being asked to go to a country where, you know, you, you can't speak with, you know, the language then, you know, don't, don't do it. Um But also just check. So I don't think it has been, it hasn't really been an issue. Um Actually sorry now that you're saying that. So the Rohingya, as I said, we are doctors, they were able to translate but they were leading the consultations, we didn't need to. But in, in Sudan, um Arab, they mainly speak, yeah, they speak Arabic. So we would do the lectures in English, but we had colleagues um that spoke Arabic. So we would say to them, look, if you want to ask the questions in Arabic, that's why people can translate. So I think you need to make sure you do have sorry now that you've said it more, more thoughts are coming to sorry, I was going to say answering more thoughts are coming to me. So um often I think so in Sudan, people weren't confident with speaking in English. Sorry, they were, yeah, they weren't as confident, understood English very well. And this is what the colleagues said. So we would encourage them to speak in Arabic and ask questions in Arabic and then translate. So it's crucial to have translators and the jos work. Um they would, they were able to fund translators for some of the talks and training we did. Um So it's not really been an issue, but I think you do need to consider it in the, in the wider picture. Um I speak English, as I said, Afrikaans, but Afrikaans is, is only really useful in South Africa. So I think I, what I would say is just you think about that in, in, you know, selectively, I know that when you are, I think you mentioned MSF requires a language. I think it, it is handy if you want to do work with MSF. And I think, you know, on a more formal basis, often II have shown the jammu route that I've gone through. But if you wanna do, you know, if you want to do um formal applications with MSF, Un United Nations, wh O et cetera, having a language, I think is often a requirement is, you know, sort of an essential criteria. So do think about learning that in your spare time. So, although it has been a slight issue, there are ways around it with the work I've done. Um And then the other question was I'm just having a look here, lots of barrier boundaries um uh career where you some examples of advice to share about keeping yourself sane. And yeah, so II, just so II just really love it. I'm really passionate about what about the international health scene? And I think the more I've done it, the, the more passionate, passionate I've become um I do II am very bounded with what I do. So II don't do work at work after hours I mean, it's having said that I did do a lot of work last night, but it's just a bit of a catch up. Um II do add on days, I didn't mention this in the talk, but I sometimes do add on time when I'm in the country to see the country and I think that helps balance it out and really immersing yourself in the cul culture and the beauty of the country. Um II, I'm trying to think what helps me keep, keeps me saying, I mean, you do really see quite, you know, there's these horrors that you see when you're out there and you, you hear particularly in the Rohingya camps um with what what happened to the Rohingya people. But I think, you know, supervision, I haven't mentioned that, but it's really important that you've got colleagues, you know, there are going to be colleagues out there. And I think, you know, the doctors worldwide team, they've got people who support you with the trip who are, who are paid, you know, paid workers with them and they do debrief and they do supervision. So I think that's crucial when you think about which organization you work with that. They do have that provision um at the conference last year, they, there was a lot more work done about supporting doctors who go out and do do such work because it can be really harrowing with what you know, the things and they stay with you. Um, uh, even if it's just the frustrations, you know, from the bureaucracy. So, um, ii feel like I wanna say contact me. Um, I don't, I haven't shared my email and I'll, I'll reflect more and get back to you about it, but I think it's just really being strict on boundaries and, and cats help. I'm going to say cats help as well. So, yeah. Um, sorry for waffling on there. Um Well, thank you so much for taking your time this evening to give us this talk. Um We'll it there, but yeah, enjoy the rest of your evening guys. Great. Thanks.