Dr Ak’ingabe Guyon
By learning about Dr. Guyon’s journey, I already felt great admiration for her accomplishments; by conducting a telephone interview, that admiration turned into inspiration and motivation. The words of this public health doctor, from a Quebec mother and a Rwandan father, are marked by wisdom, sincerity, but above all by humility. Like me, I hope that the following interview will charm you and inspire you not to be afraid of “opening the doors which seem a priori barred three times”.
Your journey to medicine could be described as atypical. What life experiences motivated you to engage in long medical studies?
Lots of things… many different elements (long silence). It was essential for me to have a profession that makes sense and is broader than my own person. A flame burns in me, which consists of a strong desire to have a profession of integrity, and which transmits hope to the people around me. Throughout my journey, I have been privileged to meet people who have encouraged me in this quest for meaning by ensuring that this flame does not go out.
My return to school, after a bachelor’s degree in physiology, a master’s degree in epidemiology and a few months on the job market, was justified by two main reasons. On the one hand, it was essential for me to better understand the complementarity between actions that repair and those that prevent. I had already explored the prevention part, upstream, and I was curious to understand the other part. On the other hand, I wanted to get closer to vulnerability, the suffering of humans, and to live and understand the miracles of healing (sometimes very surprising).
Tell us about what led you to public health, a specialty that remains unknown to many medical students.
During my bachelor’s degree in physiology, I was a nerd who marveled at the functioning of a kidney and learned the Krebs cycle. However, it was the extraordinary teachers of my optional courses, in anthropology and sociology, who changed my life. This is how I realized, for the first time, that health goes beyond repair and that I began to actively seek out experiences that would bring me closer to that.
Unlike my classmates, therefore, I already had my knowledge and experience in public health when I started my medical studies. I was dizzy when I realized that all the focus was on the curative part, while I knew very well that the preventive part had as much, or even more impact on the health of patients. As an incurable curious, I still explored other specialties during my medical studies: I was honored to be accepted in cardiology and psychiatry. It is family medicine that I initially chose with a very clear vision of wanting to work in prevention, in an environment where the clinic is more upstream and where prevention keeps its place. Then, for more structural reasons, I made the jump to community medicine residency.
When speaking to politicians, did you feel that your voice was heard? If it wasn’t, what were you doing to make yourself heard?
I have the huge privilege of having two letters after my name (MD). These letters demonstrate widespread expertise and respect for our profession, but also come with a responsibility, a duty to speak with and on behalf of our patients. In public health, I have an astronomical number of patients, nearly 8 million Quebecers, although they are treated in a multidisciplinary manner. All these factors mean that when a group of doctors speaks out, the media pay attention.
Besides, Quebec is very familiar to me. Born in Quebec to a Quebec mother and a Rwandan father, I am not perceived as a stranger when I knock on doors. It may happen that I am perceived at first sight, but my interlocutors are quickly mistaken when they realize that I know it well. All in all, I do not consider that I have faced barriers at this level, but it must be said that they are more subtle with a high degree of education compared to the barriers that face less educated people with less letters after their name.
How much easier would it have been to make your point of view heard if you were a white man?
I have no doubt about the existence of structural inequalities, linked to gender and the experience of racism. Some people are more listened to and valued immediately. I cannot compare myself to a white man since I am not one and will never be one.
On the other hand, over the years, I have realized that it is common to think that a door is locked with a triple turn, but it is only once we cross it that we realize that it was not. Daring and courage are essential for us to find ways to overcome them.
For example, it is fascinating and inspiring that an apartheid president spent the majority of his life in a prison, or that an African-American president was elected in the same century in which slavery was still present! These contemporary examples are several reminders that humans have unexpected possibilities, which coexist with very strong structural inequalities. None of this is easy, but these breakthroughs give hope when the time comes to navigate in murky waters. This navigation is not done alone, but rather with highly important colleagues and friends.
Some may perceive you as a spokesperson for your gender or your community and, therefore, think that your actions must be flawless. How do you manage this potential responsibility on a daily basis?
Nowadays, it is not so unusual to come from multiple cultures. In my eyes, it is quite impossible for me to belong to a single community. I have the feeling of feeling indebted not to a group of 10 people sharing the same characteristics as me, but rather to all the humans around me. I feel closely connected with them.
I speak for a population for whom I am responsible, which means that I speak for my own ideas, my professional expertise and not for a single community. I am motivated every day by the idea of knowing that I work with integrity, in accordance with my values and the desire to reduce things that are unjust.
For other people, it is true that belonging to a single community or language can give them more strength, in accordance with the Maslow pyramid. For me, this is not the case since I have several families and it is not possible for me to choose one more than the other.
You published a catchy article “Public health systems under attack”. Where did you get the courage to write such punchy words? Have you ever feared that your words would offend other people?
It was absolute evidence, considering my expertise, that the cuts in 2015 were of unparalleled scale, that they made no sense and that they would be immeasurably damaging. Following this realization, I had the duty to say it; impossible to continue my vacation without making my voice heard. With this evidence mixed with the urgency to act, it became clear that I had to sound the alarm, but not with sweet words, all the more in the context of such a gigantic reform where public health has the most small percentage of government resources.
However, the initial title, when the article was first submitted, was much more typical of a scientific publication. It was the reviewers who asked for a more catchy title, like the content of the article! So I have to give back the credit to César: thanks to the editors and my English-speaking colleague, we found this title. Alone we go fast, but together we go further!
As to whether I have ever feared offending readers, the answer is no. I had some ease in acting and writing it all down, since I knew full well that the evidence was on my side. If people are angry or disagree, I am always open to them showing that their decision favors the most people! So I act in accordance with what I know. I keep in mind that it is normal that the democratic exercise which would give space to experts would not be a true democracy, and that it is normal to ask the opinion of elected officials and the population.
The President’s Award for Doctors of Public Health in Canada was presented to you in 2018. How did you react to this honor? What has changed in the way you work?
I remember that moment very well! I received and read the email during a conference with colleagues. I just couldn’t believe it and I couldn’t help escaping a little sound that testified to my surprise and gratitude. I was all the more touched that this award came from fellow public health physicians who were able to understand the scope of my work and who wanted to pat me on the back.
While I thought I couldn’t be more honored, prices continued to rocket over the following months. When I was named La Presse personality, I was especially happy that preventive medicine was put forward and that my work, which makes me so proud every day, was put in the foreground. The Royal College also put me forward as a renowned medical specialist, and I was treated to a photo session in my workplace, surrounded by my colleagues without whom my work is impossible! Last summer, I received the CMA Service Medal, which earned me the honor of speaking to 1,000 fellow members at the annual forum. My ego is therefore sated for the next few years (laughs), even if it is not at all for the prizes that I work! This sequence of events was unimaginable to me. Even if I had not raised my hand for that initially, I got infinitely more: a focus on prevention!
Paradoxically, all these honors have made me more determined that my daily work should make sense and act on central elements (and not disperse myself to brew storms in glasses of water). Speaking with a colleague I admire so much, Trevor Hancock, I asked him how he managed to still have the energy to get up every morning and say what’s wrong with the population’s health. His answer still follows me today: there are many battles to fight for human life to be more just and happy, but ultimately what is most important is to choose a battle while enjoying it! So I think trying to help each of our patients get better without enjoying it is doomed to failure. In the same line, my work is also possible, because I am surrounded by colleagues with whom it is good to laugh with joy or cry with discouragement, with whom I have fun and complicity in daily actions.
What do you think is a strong woman? And a woman leader?
Being a strong woman means not accepting or reproducing misogyny, whether implicit or explicit. This is important work to be done by both men and women. It is essential to realize that each voice is unique and strong. Even if a group of people does not have the upper hand, the courage to unite and assert their common voice often pays off in the end.
To be a woman leader means to me to put participative leadership at the center of its priorities, drawing on the collective intelligence of the people we are trying to serve, regardless of their number of studies. The correlation between years of study and intelligence is minimal, since intelligence encompasses cultural and experiential intelligence, essential for making decisions collectively.
What advice do you have for future generations of women in medicine, especially those from underrepresented communities?
My first piece of advice is currently pinned on the bulletin board in front of me. This is a quote from Oscar Wilde: “Wisdom is to have dreams big enough so that you don’t lose sight of them when you pursue them.” Being daring is essential and this is the first ingredient I wish for humans, especially those who feel that their voice is not always heard as much as it should be.
My second piece of advice is also a quote, this time from Marta Graham, a dancer of the last century: “Each person has a vitality, a force and an energy which is unique”. There will therefore be no other Fatine Karkri in humanity, you are the only one that humanity will know! If we block the expression of this life, that voice will go out and be lost forever. It is therefore a privilege and a responsibility to assert our voice, our unique vitality.
Finally, I will conclude this interview by reiterating the importance of surrounding yourself with friends and mentors. “If we could see further, it was because we were standing on the shoulders of a giant. Such a support network adds joy, clarity and inspiration to what we do and we must not be deprived of it.
The #HonneurAuxFemmesMédecins campaign, which has just been launched by the Royal College, will feature a portrait of Dr. Ak’ingabe Guyon in the coming days. In addition, the book “That’s why I’m a Doctor: Physicians Recount Their Most Memorable Moments” by Mark Bulgutch will be launched on March 13. The fabulous story of Dr. Guyon will be featured.