To the 2018 Graduates: Don't just climb the ladder of opportunity; turn back around and assist those still struggling to make their way up.

"I have learned from them and others that one of the best ways to pay forward your privilege is to be an ally. Don’t just climb the ladder of opportunity; turn back around and assist those still struggling to make their way up. Life is unfair, but almost always it is unfair in my favour. The best way to show gratitude for all that I have that I have not earned, is to pay it forward."

Valedictory Address, June 21, 2018 Postgraduate Graduation Ceremony
Dr. Nabiha Islam

I am honoured to be standing here today. Surprised, but no less honoured. Those of you who are closest to me understand that my particular journey through four years of medical school and four years of residency here at U of T has been filled with many moments which I am eternally grateful for and many challenges I never expected to face. So today I want to share with you some of those experiences and what I learned from them, in the hopes that they might benefit or resonate with you. I have whittled this down to the five key lessons I learned while at UofT.

Number five:

Be authentically you.

Let me tell you a story about a time that I was not authentically myself. One of my first nights on call with my senior resident, I remember getting a consult at 4am, right around the time that I needed to perform Fajr or dawn prayers. Instead of telling my senior that I needed a few minutes to go pray first, I told him I needed to go to the bathroom, and then surreptitiously made my way to the multifaith room in the hospital to pray. The next day, post-call and groggy, I didn’t remember much about the patients I had seen. But I did remember this feeling of being a smaller version of myself. Why did I lie? Why did I feel so embarrassed about performing one of the pillars of my faith, something I had done five times a day since I was a child? Becoming a physician didn’t change my commitment to my faith, but the process of training to become a physician had led to an overwhelming need to conform – a need to be a person whose sole purpose was only to be the most intelligent, efficient, hard-working medical student or resident. I made a commitment from that day on that I would never again lie about needing to pray, and by extension that I would always strive to be my authentic self. And as I went through my training and became a senior myself, I tried my utmost to create a space safe for my juniors to feel comfortable doing the same.

Much of this was challenged by my experiences in the OR. I remember one particular supervisor who would openly and violently condemn any and all who practice Islam. When he wasn’t picking out female nurses in the hallway to take home, he was asking me questions like, “Would you really want your children to be Muslim?” Though I and others came forward with our concerns, he continues to teach learners, helping to create the culture of silence that we have seen being challenged more recently in industries like Hollywood, but which the field of medicine has yet to take ownership of. In addition to this, I was repeatedly denied the right to scrub in to the OR on the basis of my hijab. While every bone in my body wanted to just forget the daily humiliations that had become my new norm, hearing from other hijabi and Sikh colleagues about similar struggles strengthened my resolve that this should never again happen to any other learner. So I got involved in writing a hijab and religious attire policy for the OR. Unfortunately, several years on, the results of the Voice of the Resident survey indicate that we have a long way to go. Upon surveying over 1,000 residents at U of T, 44% had experienced discrimination or harassment during their training and of those, a shocking 60% were visibly identifiable as Muslims.  What does all of this mean? While U of T justifiably prides itself on being a pre-eminent institution with some of the greatest thinkers, innovators and educators in the world, it also shows us that change needs to happen at U of T: institutional change. The kind that allows learners of all religions, ethnicities, abilities, genders, orientations and socioeconomic statuses to be their authentic selves. I have learned that you can love something and still be its fiercest critic. And that doesn’t make you any less loyal. What it means for me is that I want to see a better U of T, a more equitable U of T. Because we can do better, because we MUST do better.

Number four:

Tell the people that matter, that they matter.

Each one of us in this room has made innumerable sacrifices to get to this point in our careers. Our schedules were often unpredictable and with the 80-hour work weeks and 24-hour calls filled with frantic Code Blues and sometimes an overwhelming number of patients, I know many of us had little time leftover to be with those who matter most. We have missed birthdays, anniversaries, baby showers and weddings. Sometimes, we have even missed our own. But the family and friends you brought here today to witness your graduation have also sacrificed tremendously. They allowed us to miss those birthdays, anniversaries, baby showers and weddings, usually without making us feel too guilty. Mom, Dad and Sis, I hope you know that if I have had any success in my life it is because of your friendship, love and unwavering belief in me. I encourage all of my fellow graduates to go home tonight and tell the people that matter, that they matter.

Number three:

Recognize your privilege.

This is difficult to do, and requires learning and unlearning much of what we know. I remind myself of the importance of this whenever I embark on a new project, whenever I am working with a new group of people. Who is it that does not have a seat at the table? Really challenge yourself to think about this when you are in a position to make decisions on behalf of others. Every single one of us in this room bears a stamp of privilege. Perhaps it is the fact that you are male, able bodied, cis-gendered, heterosexual, white, well-educated, or grew up in a middle or upper class home. Whatever I have left out shows you the blind spots in my own sense of privilege. If nothing else let us at least acknowledge that we are standing on the traditional territory of the Wendat, the Anishnaabeg, Haudenosaunee, Métis and the Mississaugas of the New Credit First Nation.

Number two:

Pay forward your privilege.

During the more difficult times in my training, I appreciated the most, those individuals who used their positions of power and privilege to raise my voice and the voices of those who had been similarly discriminated against. Many of these individuals I am proud to call my mentors and friends. People like Dr. George Christakis who asked me to write the hijab and religious attire policy for the OR. People like Dr. Lisa Robinson who as the Chief Diversity Officer has pushed forward many new initiatives like the Black Student Application Program and the Diversity Mentorship program. And people like Dr. Lisa Richardson, who has led many innovative initiatives on Indigenous health education. I have learned from them and others that one of the best ways to pay forward your privilege is to be an ally. Don’t just climb the ladder of opportunity, turn back around and assist those still struggling to make their way up. Life is unfair, but almost always it is unfair in my favour. The best way to show gratitude for all that I have that I have not earned is to pay it forward.

Number one:

Be an active witness.

Much of what we do in medicine revolves around witnessing another’s suffering and committing to the amelioration of that suffering. It is perhaps our greatest privilege as physicians. Over the last year, with the support, advice and mentorship of my program lead, Dr Umberin Najeeb - a support for which I am forever grateful - and armed with the necessary knowledge and experience that I could only have gained at U of T, I spent two months working in the Rohingya refugee camps on the border between Bangladesh and Burma. The Rohingya are a predominantly Muslim ethnic minority who have been denied citizenship since 1982, which renders them essentially stateless. They are denied the right to practice their faith in Buddhist-majority Burma, and have little to no access to education and healthcare in their own homeland. Many of my patients told me that each time the Rohingya community cobbled together some money to start a primary school for their children, it would be razed by the Burmese military and/or civilians. Mosques were frequently set alight. Women seen wearing the hijab (head covering) would be beaten and stripped in the streets. Many of my patients told me of much worse.

One of my clearest memories of the camps is of a time when I was making my way through the winding paths between the densely packed tents, side-stepping human urine and stool, in search of the sickest patients. I am called into a tent by a Rohingya father gently cradling the body of his two-year-old son, a body covered almost entirely in third degree burns. He tells me his village was burnt to the ground by the Burmese military and civilians who backed them. He recalls vividly the scene of his final moments in his homeland. He managed to pull his two-year-old son out of the burning flames of his home. As he fled with his son, he realized his nephew was missing. He turned back only to see the Burmese military throw his five-year-old nephew into the flames of his burning home. I ask him what he wants the world to know. He says quietly, “The Burmese military and civilians who backed them must be taken to trial in an international court of law.” I could not agree more. While the Rohingya genocide has reached its final stages due to international inaction, we as a nation and as a broader international community, have not fulfilled our legal responsibilities to prevent and stop genocide under the UN’s Genocide Convention – which both Canada and Burma are signatories of.

Our responsibility now, as physicians and as human beings, is to bear witness. To show the Rohingya and all those who are similarly persecuted on the basis of their identities, that they do not suffer alone. For in the words of Desmond Tutu, “If you are neutral in situations of injustice, you have chosen the side of the oppressor.” I hope this is something we will all remember as we move forward into our future careers.

Thank you and congratulations to all of my fellow graduates tonight.