Q&A with a public health physician
Dr. Jasmine Pawa discusses the challenges of working in public health during the COVID-19 pandemic.
Jasmine Pawa, MD, CCFP, MSc, FRCPC is a Public Health and Preventive Medicine specialist. She is currently president of the Public Health Physicians of Canada (PHPC). We caught up with Dr. Pawa recently to ask about her experiences and challenges working during a pandemic.
How would you describe your role since the pandemic began?
Alongside my role with PHPC, I work as a public health physician who does consulting and contract work. I’ve spent most of my time during the pandemic supporting a northern region as a medical officer of health. For most of us working in public health, COVID-19 has really consumed the focus for 2020, and I know many of us worry about public health work that we’ve paused or delayed.
“It’s often felt like building planes as we fly them, as we rapidly put in place and adjust public health measures with constantly shifting evidence.”
What is your typical day like? How has it changed?
The days have been long and tiring during the COVID-19 response. It’s often felt like building planes as we fly them, as we rapidly put in place and adjust public health measures with constantly shifting evidence. I work with our teams on case and contact management, and with our epidemiology teams on how we’re tracking and reporting on the response.
Most of the calls on-call right now are COVID-related but there are also some rabies questions, water quality, and other public health issues that come up. At night, I review documents, catch up on communications, review evidence, and do program planning.
I’ve tried to continue moving forward other public health work, like the immunization and sexual health work our teams had planned, as well as maintain volunteer, teaching, research, and clinical practice commitments. But it’s been hard and COVID has really taken over.
Since the pandemic broke, what has been the toughest part of your job?
Public health is often behind the scenes; it can be a challenge to articulate what we do. Public health and population health approaches are very different than one-to-one health care and require a different set of expertise and experience; as a physician, these are typically gained through years of residency and practice. This is exceptionally important for the decision-making and ethical implications for population-based decisions and recommendations for public health measures.
What are some of the biggest challenges being brought forward by your members?
The workload has been enormous and I hear from public health colleagues how exhausted they are. So many public health physicians and the teams they work with have been going non-stop for months. We’re trying to find ways to support them, but we’re facing the reality of being part of the public health response during a pandemic.
Many are finding it particularly challenging when physicians who are not trained in public health comment on population-health approaches. Robust debate is important and we all bring pieces of the puzzle within certain scopes and expertise as academics, health care providers and public health practitioners. When training and practice scopes are misunderstood or not clearly represented, these comments undermine public trust in the response; however, we worry about the impact on being able to control this pandemic. We can all have views as members of the public but we need to be careful how we represent the scope of our medical expertise as physicians.
The ethical implications and unintended consequences of the COVID-19 public health measures also weigh heavily. The goal is to minimize the effect of COVID-19, but also to minimize the broader societal impacts of these response measures.
How has your training helped to prepare you for your role in the pandemic?
The public health and preventive medicine residency training has been invaluable. We do several years of rotations with a public health focus alongside the health care and academic qualifications. For me, it included training with more than three public health units, two ministries of health and with the World Health Organization. This training is quite different to other specialty training programs where the majority of residency training occurs in clinic and hospital settings.
This experience allows me to make critical public health decisions that incorporate a broad range of factors from a population perspective. The training is much broader than communicable disease. It includes a solid foundation in surveillance, population health assessment, health promotion, emergency preparedness and response, and disease prevention. The areas where we can apply these skills to improve health are many: environmental health, mental health and others, including the current COVID-19 pandemic.
There has been criticism about confusing public health messages during COVID. What should change?
It is expected that the messaging is going to need to change along with the evidence. We will always have a lot of work to do to coordinate between levels of government in our federated system to share information and bring a consistent public health approach. There were many learnings from SARS and other public health emergencies – for example on public health data information systems – that we have only partway implemented and need to continue to pursue.
Can you offer some tips on how other physicians can support their public health colleagues?
I’m hoping that we can all recognize that, while both are valuable, one-on-one health care work is very different than public health work. We can thank all those who work in public health organizations including public health nurses, public health inspectors, epidemiologists, educators, and others. As physicians, we can recognize the unique expertise and training of Public Health and Preventive Medicine specialists that underpins their ability to make population-based decisions that are critical in a pandemic.
Overall, I am grateful to everyone in health care and public health working hard to respond as best we can. We have all undergone so many personal and professional changes to adapt, and I’m hoping we can continue to be kind and respectful to each other, even when we disagree. Throughout this, I also think it’s very important that we also be mindful of the assumptions, biases, privilege and lenses we bring no matter where we are working.