Latest / Flourishing in Medicine: From Surviving to Thriving / Flourishing in Medicine: From Surviving to Thriving Episode 20 Mindfulness and Resilience in South African Healthcare with Dr. Janine Kirby

Transcript

Flourishing in Medicine: From Surviving to Thriving Episode 20 Mindfulness and Resilience in South African Healthcare with Dr. Janine Kirby · Flourishing in Medicine: From Surviving to Thriving

• 0:00
  I'm not so interested anymore about what happens to me, but about who am I and what are the
• 0:12
  strengths and resources I can bring to what happens to me. And so I think that a lot of
• 0:20
  what we're doing in mindfulness is connecting back to the source of our being as to who
• 0:26
  we are and the strength of who we are. And that for me is always so much more interesting,
• 0:33
  you know, when I'm in conversation with patients or in working with groups of people is actually
• 0:39
  what are our strengths, who are we and what is it that we can bring to this moment. And
• 0:46
  to reflect how in South Africa we've learned that lesson a lot because we've come through
• 0:51
  some terrible times and we still go through terrible times, but somehow there's something
• 0:59
  about us that's kind of strong and joyful and resilient. And when the electricity goes
• 1:06
  off, we just shrug our shoulders and keep going on because that's what happens.
• 1:14
  Welcome to Flourishing in Medicine from Surviving to Thriving. I'm your host, Dr. Mick Krasner,
• 1:20
  and the podcast is produced by EmPRO, a medical professional liability insurance carrier headquartered
• 1:25
  in New York State. EmPRO is committed through a number of peer support offerings to supporting
• 1:31
  the physicians they protect. And this podcast, Flourishing in Medicine, is a place where
• 1:35
  we explore conversations with thought leaders on how health professionals, physicians, and
• 1:42
  others can best flourish within the challenging environment of healthcare today. The title
• 1:48
  of today's podcast is Mindfulness and Resilience in South Africa, Healthcare with Dr. Janine
• 1:55
  Kirby. So our guest today is Dr. Janine Kirby, a family practitioner from East London, South
• 2:02
  Africa, who is the chairperson for the Institute for Mindfulness, South Africa. She's dedicated
• 2:08
  her career to interrogating the healing spaces that exist within fractured, traumatized,
• 2:14
  and yet resilient communities of South Africa. She's a true educator. She has a passion for
• 2:19
  helping her patients, her colleagues, and her students to understand the importance
• 2:24
  of the intimate connection between body, thought, emotions, and healing. In this conversation,
• 2:31
  Dr. Kirby discusses how her early life in apartheid South Africa and her family's response
• 2:36
  to her brother's illness shaped her holistic understanding of healing and highlights the
• 2:41
  integration of traditional and modern medical practices. She emphasizes the importance of
• 2:46
  mindfulness in managing moral distress faced by South African medical professionals, the
• 2:53
  resilience and community spirit in South Africa, and her commitment to expanding mindfulness
• 2:58
  programs and nurturing compassion through the philosophy of Ubuntu, a South African
• 3:04
  philosophy emphasizing that a person's humanity is interconnected with the humanity of others.
• 3:12
  Dr. Kirby's thoughtfulness, compassion, sensitivity, and commitment were really gifts
• 3:18
  and a reminder to me of the challenges and the promises of flourishing in medicine. I
• 3:24
  hope they'll be a gift to you as well as you listen. And now my conversation with Dr. Janine
• 3:29
  Kirby. Welcome to flourishing in medicine, Janine. It's really lovely to have you here.
• 3:36
  Thanks, Mike. It's really lovely to be here and to be with you again.
• 3:40
  Yeah, I'm looking really forward to our conversation. And I'd like to actually begin that conversation
• 3:47
  the way I tend to begin with other guests, which is to hear from you a little bit about
• 3:53
  your story of why, the why for you in medicine. You know, a lot of our colleagues and myself
• 4:01
  included, there are a lot of reasons and experiences that sort of motivated us to endure the challenges
• 4:10
  of medical training and the lengthy education and the challenges of practicing medicine.
• 4:16
  Some of it maybe comes from our childhood experiences. Sometimes it's things that have
• 4:20
  happened in our work life, early adulthood, etc. But walk us through that, what we could
• 4:27
  call your origin story of why medicine among all the other things that you could have done.
• 4:33
  Thanks Mike. It's a really good question that I think many of us ask much of the time. My
• 4:39
  first experiences with illness was as I was born. When I was six weeks old, my brother,
• 4:48
  who was 18 months old at the time was diagnosed with the craniofaringioma, a brain tumor.
• 4:54
  My parents noticed that he was blind and he had surgery when I was six weeks old and my
• 5:03
  mother went into nursing, which was the only way at the time in the early 1960s that she
• 5:08
  could be with him. And my father became my primary caregiver at the time. And so I suppose
• 5:16
  from very early on, I was almost an observer in what was happening in my own family with
• 5:24
  my very ill brother and his need for our hormones and to try and stabilize and balance him and
• 5:31
  all his educational and medical needs. And watching how my parents did this in their
• 5:38
  own unique and different ways. My mother's a very practical person. She's a nurse. And
• 5:43
  so she was looking after him and his physical needs. And my father was a very reflective,
• 5:51
  thoughtful person who really was trying to grapple with this and to understand what it
• 5:56
  meant and what healing meant as opposed to a child who was getting better. And my brother
• 6:05
  died when he was nine and a half and I was eight. So that was really very formative for
• 6:13
  me. And I would have to say also simultaneously, you know, I was born into apartheid South
• 6:18
  Africa and born into a place of systemic division and separateness. And that even from a very
• 6:27
  small child really couldn't understand this and couldn't really understand how to divide
• 6:34
  things up into different parts. So I think these were two narratives which have followed
• 6:41
  me through my life. It was actually really about how to find a sense of healing and how
• 6:50
  to draw things together as well as how to be present in the midst of difficulty.
• 6:57
  So that certainly had probably profound and lasting impacts that have sort of rippled
• 7:04
  forward and perhaps backward in some ways. And you mentioned healing. You used that word
• 7:10
  a few times. I'd be interested in how did you understand or what can you formulate even
• 7:16
  now even if some of it is conjecture, what your father actually thought about what healing
• 7:23
  meant, what your mother did with the way she approached things and then how that has formed
• 7:28
  your own sense of what healing is and how you saw it early and maybe how it's changed
• 7:33
  because I'd imagine through your work life and being exposed to suffering on so many
• 7:38
  levels as a professional that that healing notion and definition maybe has changed a
• 7:46
  bit.
• 7:47
  Thanks for the question, Mekhamen. I think healing and wholeness for me are very similar
• 7:55
  words and the healing is this gathering up and it's somehow the integration of both aspects
• 8:04
  of both physical healing as well as mental and emotional healing. And so maybe I can
• 8:13
  tell you some more stories about myself. So one was actually this one aspect of healing
• 8:20
  which is around the way in which we taught at medical schools. And as we know, it's very
• 8:25
  rigorous. It's very protocol based, evidence based. It's not really creative, these kind
• 8:32
  of certain ways of doing things. And on the other side of that is this other sense of
• 8:40
  healing, which is very intuitive and creative and it's a kind of it's a different spiritual
• 8:46
  space. And I really came up against this working in Africa is that an African sense of healing
• 8:54
  is very different to how African healers or traditional healers heal is not the way in
• 9:00
  which we would see healing. When I was studying family medicine, and we spent one of the weekends
• 9:07
  of our family medicine training at a small rural hospital where we met the traditional
• 9:13
  healers in this particular valley. And they invited us in the middle of one night to go
• 9:20
  and meet up with their father or their trainer. And so this was in the early 90s, which was
• 9:27
  a very politically inflamed time in South Africa. And we went bumping down the road
• 9:33
  literally in the middle of the night and came to this little house where there was a paraphene
• 9:39
  lamp in the middle with all these traditional healers that were singing around it. And it
• 9:44
  was at the house of somebody who had been one of the ANC stores in the early 1900s.
• 9:51
  And it was his granddaughter who was being inducted as a traditional healer. And they
• 9:56
  did a little ceremony for us where they showed what it means to be a healer in the middle
• 10:01
  of this dark night. But a traditional healer, you don't tell your story to the traditional
• 10:09
  healer, the traditional healer sensing within him or herself where or what the problem is.
• 10:16
  And the person doesn't come as a person, they come as a family. So it's like, you know,
• 10:21
  I feel that you all you have a problem with your stomach and the family would say we agree
• 10:26
  or we don't agree. And this is what you need to do for your stomach and the family would
• 10:30
  say we agree or we don't agree. So it's this really it's a sense of a collectiveness. It's
• 10:35
  very intuitive. And it's it's very different way of healing to the way in which which we
• 10:42
  work. And so I have spent my career always trying to find ways to integrate both of these
• 10:53
  sides like both the separateness and the togetherness and both the allopathic and the more
• 11:00
  complementary forms of medicine, both the reductionist, the mechanistic as well as the
• 11:06
  intuitive, the creative, the listening.
• 11:10
  Thank you. I am really intrigued by this subject, especially as it relates to your interaction
• 11:18
  or contact with traditional healing and it wasn't the area of the interview I thought
• 11:22
  we'd be going or the conversation I thought we'd be going but I think it maybe has some
• 11:28
  way of returning us back to kind of this whole flourishing and medicine focus. So let's see
• 11:35
  where it goes. Maybe we'll just explore this or digress and maybe it'll just be a digression.
• 11:41
  But I'm really interested in this initiation right and also this notion of how they actually
• 11:46
  interrogate patients and families around illness or how these traditional healers might do
• 11:52
  that. I was influenced or read somewhat a cultural anthropologist you probably know
• 11:57
  of her, Angelus Arian, who studied indigenous healing cultures and interestingly enough,
• 12:04
  I had some images as you were speaking. She talked about four questions from all her studies
• 12:08
  of multiple different indigenous cultures that what a healing specialist, a traditional
• 12:15
  healer would want to know about a person or a family. And there were four questions and
• 12:20
  I'll pose them to you and maybe you can reflect on whether that connects or kind of makes
• 12:25
  sense to you. Four questions that the healer would ask and the first is when did you last
• 12:30
  sing? When did you last sing? The second was when did you last dance? When did you last
• 12:36
  dance? The third is when were you last enchanted by story? And then the final one is when did
• 12:41
  you last enter the sweet silence? And I'm just curious about, you know, these are of
• 12:47
  course of metaphorical value, but thinking about that and your encounter and living within
• 12:53
  a system where some of these somewhat coexist depending on where you are I'm sure in South
• 12:57
  Africa and then bringing your own sort of combination of complementary and more allopathic
• 13:04
  approaches to medicine. I'm just interested in your reflections on what I just shared.
• 13:10
  Yeah, I mean, they're such loaded questions aren't they Mick? And they're definitely not
• 13:15
  the questions that we ask our patients when they come in to see us. And so, you know,
• 13:20
  we get so hung up on symptom that we actually forget to ask those questions as to the things
• 13:29
  which give joy and which spark joy and give meaning. And I think that's often why people
• 13:36
  burn out is because there is this lack of connection with another person, this lack
• 13:42
  of hearing another story, and this this lack of really connecting with this person on the
• 13:49
  other side of you of what gives them meaning and where they're at. So those are beautiful
• 13:54
  questions.
• 13:55
  Yeah, I agree. It gets at some other element of what it means to have vitality, doesn't
• 14:01
  it? Whether it's in your community or within oneself and also what it takes to have that
• 14:08
  which sometimes means solace and solitude and really reflective times as well. And which
• 14:14
  we I think we will come back to that because I know it's a big part of your professional
• 14:20
  and communal life. You mentioned the apartheid and how difficult things were growing up,
• 14:26
  trying to understand like the separation and then also the 90s being a lot of turmoil as
• 14:32
  things really began to happen and change in South Africa. And could you share with the
• 14:38
  listeners just how training medical training delivery of health care in broad senses? You
• 14:46
  could spend a whole couple hours on this, but just as it affects the way you practice
• 14:51
  the Organization of Medicine in South Africa, what are the challenges? What's it been like
• 14:55
  to practice medicine here? And then maybe I can bring you back to this if we go off
• 15:03
  on a tangent. What is the lived experience for physicians in South Africa in terms of
• 15:10
  like the challenges and the burnout? Because you've written about it. I've read a beautiful
• 15:15
  article in the South Africa Family Practice Journal that you had written very recently,
• 15:20
  which kind of goes over some of that. You know, Mick, things have changed a lot of the
• 15:25
  last 30 years. But when I was a young doctor, I think maybe this, yet again, telling a story
• 15:32
  will give you an indication of what it was like. And so I did my internship here where
• 15:38
  I am in East London, which is on the eastern seaboard of South Africa at a hospital called
• 15:44
  Brave Hospital. And at the time, the hospital was literally divided in five. And there was
• 15:51
  a gate literally in the middle, which was locked at four o'clock after the outpatient's
• 15:56
  units closed. The only reason that gate was unlocked was for the staff to be able to move
• 16:02
  from one side to the other. And the one side was for white patients who were in the minority.
• 16:09
  And the other side was for black, coloured and Indian patients because everybody was
• 16:13
  designated according to race. And so we had this really awful and frustrating time when
• 16:22
  we would go on call at night knowing that half the hospital was empty and the other
• 16:27
  half we were literally thinking about floor beds because it was so full. And so it was
• 16:35
  this really obvious, in our faces, painful, dehumanizing, separateness that we were having
• 16:43
  to deal with every single day and actually just feeling quite powerless as to what to
• 16:49
  do about it. And so I think then what happened is in my early years as a doctor is that quite
• 17:00
  soon thereafter, fortunately, South Africa did change and we've now just celebrated 30
• 17:06
  years of democracy. But the echoes of that system carry on, they live on and they live
• 17:14
  on still with just, you know, vast differences in actually mainly in income. And so that
• 17:22
  still black South Africa tends to be very poor and white South Africa tends to be richer.
• 17:30
  And of course, it tends to be. And that's why South Africa, we were afforded really
• 17:38
  excellent education while people of color were intentionally given very poor education.
• 17:44
  And so the ripples of that continue. But I think one of the things we struggle with most
• 17:51
  is actually the trauma. And so it's a very, very traumatized country. We are traumatized
• 17:59
  and there is a lot of trauma. And then we have all the ills that go with poverty and trauma
• 18:07
  with gender based violence. We have the highest incidences of HIV AIDS, TB, and then obviously
• 18:14
  malnutrition, everything else that goes with it. So I think often one of the difficult
• 18:20
  things for us is that what we are dealing with is really societal problems, people who
• 18:26
  don't have jobs and often feeling as if we do a much better job if we were just giving
• 18:33
  people work rather than calls. So I think that is difficult. As one is the fact, our
• 18:39
  health systems in the past were very separated and divided and they aren't really that well
• 18:47
  integrated. And I mean, as with all of us, we deal with difficulties within the health
• 18:53
  systems as well. And that also, as we know, adds significantly to stress.
• 18:58
  So maybe you could say a little bit about as the practitioners, the medical professionals
• 19:04
  and especially the physicians are practicing in this environment, the kinds of moral distress,
• 19:11
  of course, that they would experience back before democracy came in was of a certain
• 19:19
  flavor and those echoes are still there as you described. But there are certain thinking
• 19:25
  about certain levels of moral distress, moral injury that practitioners have, sort of trauma,
• 19:31
  I guess we could even say, in facing resource allocation issues because of wealth disparities,
• 19:40
  but also facing that legacy of apartheid in the delivery of health care. And how does
• 19:47
  that affect the well-being of the workforce, especially the physician workforce?
• 19:52
  All of us are working in a sea of suffering and that's just our particular flavor. And
• 19:59
  we can't be working within these very traumatized communities without experiencing some of the
• 20:05
  trauma ourselves and without feeling some sense of helplessness. I think that medical
• 20:15
  students and doctors and medical staff aren't trained to be tuned in to these levels of moral
• 20:25
  distress. And so I think that a lot of the people that we see coming through our programs
• 20:32
  is that they just know that something isn't right, but actually don't really know what it is.
• 20:39
  And I think that's why mindfulness is so extremely helpful, is that it gives us a way in to tune into
• 20:47
  and to become aware of this and to become aware of how hard it is to be working the way that we
• 20:54
  work and in these very difficult circumstances. I think I also just want to add to this is that
• 21:04
  South Africa, as you know, is a country of extremes. So that while on the one hand we do have all of
• 21:11
  this trauma and all of this pain, on the other hand, is we also have such resilience. We have a joy,
• 21:22
  we have an ability to dance and to sing and to be present and to care for and to love and to be
• 21:30
  present and to care for and to love. And so it's not just that it's all doom and gloom, but
• 21:39
  we have inner resources within us that we can and do draw on. And also the sense of collective and
• 21:47
  community and not just like feeling a sense of isolation and it's just me. Yeah, I agree with
• 21:55
  what you said that you talked about the unique things that health professionals and physicians
• 22:01
  struggle with in South Africa could be seen as just a flavor of the encounter with suffering that
• 22:06
  everyone who works in medical care professions experiences everywhere. And I think to an extent
• 22:13
  that's true. I thought I was really curious how you talked about how people have a sense that
• 22:20
  something's not right themselves, the professionals, but aren't quite sure of what it is and where it's
• 22:26
  come from and what to do about it. But you wrote about burnout in South Africa and some ways that
• 22:35
  self-care can be one of the things that we can use to help that. Is there a sense among the profession
• 22:42
  of medicine, especially physicians and maybe medical leadership, the people who are in policy
• 22:49
  positions of actually the costs of a workforce, especially highly educated and trained workforce
• 22:59
  that is suffering burnout? And I'd like to come to mindfulness in a second and talk about your
• 23:05
  leadership in that. But are there other things people are trying to do to address it as well as
• 23:11
  the mindfulness that you have been promoting? I think that people are becoming much more aware
• 23:19
  of burnout and certainly in our local literature, more people are writing about burnout,
• 23:26
  but very few people are writing about what to do about it. And yet again, you alluded to the fact
• 23:33
  that we are resource-poor. And so when one is resource-poor, it's actually resources aren't
• 23:41
  placed in caring for doctors. It's kind of like the doctors have got money, the doctors have got
• 23:48
  cars, the doctors have got positions of status and power in the community. Like what are they
• 23:54
  wanting about? Like what's this all about really? And I really, I don't think that it is seen as
• 24:03
  something which needs to be addressed at a high level or I'm not aware of people thinking this
• 24:11
  through. I mean, as I say, people are talking about it, but not really about what to do about it.
• 24:18
  I think that you just have so many other low-pressing concerns that seem to have been
• 24:24
  prioritized ahead of that. Yeah, thank you for that honest assessment. And I think here we might be,
• 24:31
  I don't know if we're any further ahead, except there is an extant body of empirical literature
• 24:38
  that has connected well-being of physicians with so many outcomes issues that I think it is
• 24:44
  something that if you really look at that research, this is a real issue for regular folks who want
• 24:52
  medical care in terms of access, in terms of quality of care, in terms of the quality of the
• 24:59
  experience of that care, in terms of medical errors. There's just a whole literature around this.
• 25:05
  So I don't think anyone, if you really looked at the literature, could question that connection.
• 25:10
  Well-being in higher quality and not so well-being and poor quality of care. So I think there's a
• 25:18
  really strong argument to make, but it's true when the issues at hand are related to very little
• 25:26
  resources and then you have professionals who seem to be in positions that they seem to be doing
• 25:32
  okay. And actually I would argue that they're not so okay and some may actually leave causing,
• 25:39
  exacerbating either additional pressure on the shortages of access and care, that sort of thing
• 25:47
  that, you know, waking up to that is a challenging task to getting our leaders, especially in
• 25:53
  policymakers in particular, awake into that. So I do think that people that feel, as you described,
• 26:01
  that something's not quite right, it's a good place to start, isn't it? So perhaps you can
• 26:06
  share with us a little bit about your own journey in mindfulness and then your journey toward
• 26:12
  leadership and tell us a little bit about AMISA as well and how you think about some of the work
• 26:19
  you're doing there. I know it's not your complete focus of the work, but I think you are working
• 26:25
  with professionals and at least thinking about how this could be applied to health professionals
• 26:30
  and physicians to help them flourish. So I burnt out myself when I was working in the health center.
• 26:38
  It was in the early 90s and I was the only white person working in this health center and so
• 26:45
  a lot of the toxicity and the pain and the blame of apartheid landed on me and so that was very
• 26:55
  difficult. Also in the 90s, obviously, which was the beginning of the AIDS pandemic and our current
• 27:02
  president was an AIDS denialist and so it was really difficult because we had these young people
• 27:08
  coming in who diagnosed with AIDS and at the same time our president was saying there's nothing
• 27:15
  wrong with this, there's no such thing as AIDS, it's just a problem of diet and food. And also
• 27:22
  just working in a system which was very constrained, allopathic medicine, very tight, needing to see
• 27:28
  patients, lots of patients very quickly and having no real relationship with the patients. So
• 27:35
  I burnt out and as a result had to leave where I was working, which was very difficult for me
• 27:42
  because I thought it was where I was called to be working and spent time in reflection
• 27:48
  and deciding where was my role, where did I need to be and part of that answer came through
• 27:56
  mindfulness and through the power of silence and of presence and reflection and of really turning
• 28:11
  into who I am on the doctor-patient relationship. You know, 50% was me and who was this person, me,
• 28:20
  what my prejudices, my beliefs that I brought into this consultation and in what way would I be a
• 28:29
  better conduit for healing as opposed to just suppressing illness. So that was really, you know,
• 28:37
  the beginning of my journey with mindfulness and then was very fortunate to have a friend here in
• 28:45
  East London, he's a psychologist and started teaching mindfulness, eight-week mindfulness-based
• 28:51
  stress reduction programs and then from there moving from just local into the more national
• 28:58
  level where I'm now the national chairperson of the Institute for Mindfulness of South Africa,
• 29:04
  OIMESA. I was very fortunate to attend a workshop with Mick in upstate New York and looking at this
• 29:14
  whole question of how mindfulness relates to burnout and healthcare practitioners and then
• 29:22
  I came back to South Africa and then we started our own program here where we run online courses
• 29:29
  for healthcare practitioners, myself and three other colleagues who are also trained in mindfulness
• 29:35
  and at the same time at OIMESA we run many programs and we have changed the way in which we train
• 29:46
  teachers in OIMESA. We pivoted quite recently from a two-year program which was in conjunction with
• 29:56
  one of our local universities to offering a 13-week program which makes it a lot more accessible
• 30:05
  where people will be able to share mindfulness practices in their place of work and we've been
• 30:12
  wanting to invite people who are working also in the NPO and NGO sector so that we'll be able to
• 30:21
  spread this idea of mindfulness much more widely rather than for it to be only for those who could
• 30:28
  actually afford to pay for the previous courses which we are running and so we're really excited
• 30:35
  about this pivot. We've also changed this training for it to be more context sensitive, more aware of
• 30:44
  how in South Africa that the relational spaces are so much more important. I think that's something
• 30:51
  we can add to the international conversation around how mindfulness is regulating and practices
• 30:58
  which regulate and around the compassion practices so that these are ways in which in our own small
• 31:05
  way we are hoping we'll be able to start these difficult conversations in South Africa and be
• 31:12
  a way in which people can use mindfulness and to bring healing into their different communities.
• 31:20
  Can you talk a little bit about what you understand or have experienced or heard from those in the
• 31:28
  health professionals who have come for that teacher level training? What's drawing them to that and
• 31:38
  what are they thinking of doing with that or actually doing with their teaching skills?
• 31:45
  You know it's a very wide range of things that people do and a lot of people never teach at all
• 31:51
  but actually just find that it's so useful personally and for their own personal growth
• 31:57
  and I guess that from that space of personal growth that does change who we are and who we
• 32:03
  can be out in the world. But I mean some people are running programs, eight week programs,
• 32:10
  but we have got some people who are running programs in Alexandria which is one of the very
• 32:16
  poor townships outside Johannesburg with young girls just in a very you know in a very poor space.
• 32:24
  We have somebody who is a doctor in Botswana and she's taking it into her place of work in Botswana.
• 32:35
  We have somebody who is a Catholic priest and was sharing it with people coming from Southern Africa
• 32:43
  on sabbatical from the Catholic Church, from the nuns and the priests. We have people who are
• 32:52
  taking it into corporate spaces, education, you know it's a very wide range.
• 32:58
  Yeah that's inspiring to hear all the different things people are doing with it and naturally
• 33:04
  something about mindfulness has us become in some ways more in touch with who we are, what our
• 33:10
  motivations, goals and desires and how we can best place our attention we could say and so
• 33:16
  it sounds like naturally people are discovering things about where they find they want to share
• 33:21
  their gifts. Maybe on a personal note let's come back kind of full circle to healing,
• 33:30
  healership, your understanding of healing and what this work in mindfulness both as a student of it
• 33:37
  and also as a teacher of it and a leader within your community and country. What are some of the
• 33:43
  things that you've really discovered about yourself and about people and about how we can
• 33:50
  be in community and maybe even help people think about their ability to sing again and dance again
• 33:58
  and be enchanted by stories and actually be in the silence and reflect?
• 34:04
  I mean it's an interesting question and it's I suppose always useful to reflect on a journey
• 34:10
  because sometimes when you're in the journey you aren't really aware of where you come from or
• 34:17
  what's happening on the journey. I think that one of the things that I've learned is that through
• 34:27
  mindfulness is that I'm not so interested anymore about what happens to me but about who am I
• 34:37
  about who am I and what are the strengths the resources I can bring to what happens to me.
• 34:47
  And so I think that a lot of what we're doing in mindfulness is connecting back to the source of
• 34:53
  our being as to who we are and the strength of who we are. And that for me is always so much
• 35:01
  more interesting when I'm in conversation with patients or in working with groups of people is
• 35:07
  actually what are our strengths who are we and what is it that we can bring to this moment.
• 35:15
  And to reflect how in South Africa we've learned that lesson a lot because we've come through
• 35:21
  some terrible times and we still go through terrible times but somehow there's something
• 35:29
  about us that's kind of strong and joyful and resilient and when the electricity goes off we
• 35:36
  just shrug our shoulders and keep going on because that's what happens. So I think the one thing is
• 35:42
  really just to be reflecting on that in a sense the core of who we are and to actually be doing
• 35:48
  practices which strengthen and remind us of that. I think that I have become kinder but that's
• 35:57
  quite intentionally so more tuned into the compassion and into the compassionate
• 36:04
  source that we have in Africa, you know our African ground and our soil and our being and
• 36:12
  the relational way in which we are together is that we very much have a sense of awareness
• 36:18
  and the collector that in South Africa we call we have this word rebuntu which means I am only
• 36:25
  because you see me and so it's about being able to see myself and to see other people so I think
• 36:32
  you are tuning into that and that warm compassion remembering my own wisdom and the really
• 36:40
  importance of having these moments to breathe out to exhale. So I think that is also one of the
• 36:48
  problems in medicine and in our world today is it sort of seems to be a good thing to be busy
• 36:56
  and we don't see that we need to be busy and we need to be quiet and the body needs to breathe in
• 37:02
  and to breathe out and we need to be awake and to be asleep and we need to our hearts need to
• 37:10
  contract and to relax and so this really important aspect of time of silence and kind of the magic of
• 37:20
  mindfulness of just making sense of and digesting. So beautifully stated you had mentioned earlier
• 37:30
  about the relational space and now you really articulated it in such a way that it really
• 37:37
  really makes sense that this practice has brought you into say more kindness or into more sense of
• 37:44
  who you are not so much worried about what happens to you but how are you going to show up for that
• 37:50
  and how are you going to show up for your connection with others and it sounds like it's
• 37:55
  both and oneself and one's relationship to others and that other as you just expressed also includes
• 38:03
  the earth you know includes the land that we live on and that we come from that we share truly share
• 38:10
  with everyone all beings that are on on the planet so lovely very lovely maybe you could say a little
• 38:18
  bit about what's in store what's kind of on your mind for the next couple of years in Emisa in the
• 38:26
  mindfulness community in South Africa and maybe even just personally for yourself.
• 38:30
  I'm not really somebody that makes too many long-term projections or has too many thoughts
• 38:37
  for the future. I think I have more like an intention rather than specific ideas about things
• 38:43
  and then as things unfold to to really all the time be asking the question what's going to be wise
• 38:50
  and most helpful but I think that our intention in Emisa is internal and ways in which we can
• 38:58
  and ways in which we can actually expand the program make it more accessible more freely
• 39:05
  available more context specific more something which can be useful on the ground not just kind
• 39:14
  of with the elite board white housewives as I said a tongue in cheek so that's really an intention
• 39:21
  of ours just to be trying to make it more diverse and then looking externally or outwards
• 39:28
  a very strong feeling that as Africans or South Africans is that we have an important voice to
• 39:38
  add to the management's conversation internationally and that that I think a lot of the time we don't
• 39:45
  say anything a lot of the trauma and of the history of South Africa means that we are often
• 39:54
  instead of a sense like the Americans are back seem to be so proud to be American and
• 40:00
  hang flags and the front doors where there's a sense of shame often and especially as a white
• 40:06
  South African a sense of shame and somehow for us to overcome the sense of of not enoughness
• 40:18
  and for us to be starting to do more research and to be exploring ways of translating mindfulness
• 40:29
  and to be part of that wider conversation. Lovely that's really beautiful and a very
• 40:38
  challenging thing to address and I was struck a little bit by when I first asked you the question
• 40:43
  like your initial response you know that you're not so strategic looking out so far into the
• 40:48
  future so I'll just share something I listened to a podcast not long ago and maybe you know this
• 40:54
  person and I he's a South African and he has written a book which I then read called the Lion
• 41:00
  Trackers Guide to Life I think it's called Boyd Vartie and Boyd and family has experienced some
• 41:06
  trauma and also worked very closely with the Shogun I think they're called Lion Trackers for
• 41:13
  millennia and he talks about how you know the tracker's job is not to find not to know exactly
• 41:20
  where that animal is but to know where the next clue is where the next track is so it's really a
• 41:26
  very close-in kind of thing like we can take the next track we if we look too far we're going to
• 41:33
  lose the track but the track right in front of us the step that's the next one to take is often
• 41:39
  something we can work with and then things open up and then we see the next and the next and the
• 41:44
  next so we don't really know where we'll fetch up on the horizon but it moves us forward and it takes
• 41:51
  a lot of attention paying attention silence and really being in relationship with the environment
• 41:59
  and the human environment and the physical environment I mean just in terms of that in
• 42:05
  the late 80s one of my friends was working with Bishop Tutu Desmond Tutu and obviously there was
• 42:13
  a lot of protests and protest action and violence etc at that time in South Africa and anytime he was
• 42:21
  about to go to some kind of meeting or there was a protest or anything was about to happen the first
• 42:28
  thing that he'd do is actually nothing he'd spend the day in silence and pray and the busier his life
• 42:36
  got the more time he spent in silence and prayer and I'm sure it's one of the reasons why he became
• 42:42
  so effective is because because he was so grounded himself yeah I think it's something that we don't
• 42:50
  give to ourselves that is absolutely necessary to I think to live a life of that's morally and
• 42:59
  ethically in the right direction and also one that we can perhaps have ease and meaning and safety
• 43:07
  and joy and happiness in by doing that so I think it's key to that and talking about happiness and
• 43:16
  joy maybe just as we close just what are some things you do to take care of yourself to
• 43:23
  experience joy I'd imagine you had shared that you're will become a grandparent and I imagine
• 43:30
  that's one of those things you're looking forward to but other things that you're you're up to well
• 43:36
  you know there's so much that I'm so extraordinarily grateful for so one of the things is I am a
• 43:43
  grandparent to obviously the sweetest smartest and cutest two-year-old and that he he gives us
• 43:49
  endless joy and just being with my family they live in Cape Town and so we are quite intentional
• 43:56
  about spending time with them but in small ways you know we live very near the beach we go for a
• 44:02
  walk every evening just being with with family and I've been creative my husband and I are very
• 44:10
  fortunate to be able to travel a lot and so I think just ways of of being present maybe the other
• 44:17
  thing is just actually I feel so fortunate to be able to eat well and to enjoy eating and to savor
• 44:26
  you know the fruits and the vegetables of the earth around us. Lovely thank you very much this
• 44:32
  has been a wonderful conversation and I think our listeners will be very enlightened and just
• 44:39
  inspired by your story and also the story of the people of South Africa that a little bit that
• 44:45
  we've heard I think it is inspiring having been there a few times and watching you teach and
• 44:51
  interact there there is a lot of joy absolutely and to know that we can have joy even in the
• 44:57
  challenges that we face as health professionals even questioning whether we can flourish I think
• 45:03
  there's there's truth in joy and in happiness that can coexist with the suffering that we
• 45:10
  encounter that we actually work with every day. Thank you. Thanks Meg. Thank you very much for
• 45:17
  listening. We will include a summary of today's podcast and links in the show notes for this
• 45:23
  podcast. I would like to conclude by sharing yet another practical exercise to help you flourish.
• 45:30
  Dr. Kirby spoke of Ubuntu, the southern African philosophy of interconnection often summarized as
• 45:37
  I am because we are. Please join me on a brief contemplation of the connections that we each
• 45:44
  have with parents, family, loved ones, friends, neighbors and entire communities and how these
• 45:50
  connections in a very significant way define our humanity. So I'd like you to just bring to mind
• 45:59
  someone close to you a parent, a family member, a loved one and maybe asking yourself who would
• 46:05
  you be without that connection, the connection with them? What would you be in the case of our
• 46:11
  parents? We wouldn't even be here right? Think about your friends, neighbors, even people you meet
• 46:18
  briefly on the street or at the supermarket or at the bank or pretty much any public space which we
• 46:25
  traverse or private space or work spaces to the extent possible be as specific as you can bringing
• 46:31
  the image of specific individuals, human beings to mind and as you hold them in your mind's eye
• 46:39
  simply asking yourself who am I without that relationship with them? Who am I? What am I?
• 46:47
  What would my life be? It doesn't take very long to really feel into the truth that in a very
• 46:53
  significant way our humanity is completely tied up in the humanity of others, our relationships,
• 47:00
  our connections, our very beings. You may want to engage in this practice anytime, especially
• 47:07
  when you feel somewhat separate, maybe somewhat exiled, maybe not sure of how you fit in or belong.
• 47:14
  It can be a way of finding yourself truly embedded in this web of humanity simply
• 47:20
  by being alive. I hope you found this podcast and this simple exercise useful and look forward to
• 47:26
  having you join us for the next episode of Flourishing in Medicine from Surviving to Thriving.
• 47:32
  To learn more about EmPRO visit www.myEmPRO.com and there's peer support programs
• 47:39
  www.myEmPRO.com forward slash peer dash support. If you're a physician or a medical student in need
• 47:46
  of urgent support consider calling the physician support line at 1-888-409-0141. This support line
• 47:54
  is a safe space to discuss life stressors with volunteers to come and help you get through the
• 48:00
  stressors with volunteer psychiatrist colleagues who not only are trained to do this but also have
• 48:07
  shared similar experiences by virtue of being part of our profession. And for information about me
• 48:13
  and my work please visit www.MickKrasner.com or www.mindfulpracticinmedicine.com. Until next time.