Spotlight

Thank you Dr. Woollard for joining us on this interview! We are really excited to have you share your experiences in rural health research. Could you tell us a little bit about yourself?

My name is Bob Woollard and I am a physician and a professor in Family Medicine at the University of British Columbia. I have been affiliated with RCCbc since its inception. I was a country doctor for 20 years before I came to the University, first in a small town in the prairies and then in Clearwater BC where I had practiced for 16 years. I was Department Head of Family Practice for two terms at UBC. When I finished my second term as Department Head at UBC, I focused a lot of my own work on rural issues at RCCbc. In addition I have been involved in issues of rural health services, ecosystem health and social accountability/justice in various parts of the world. That has been a central focus in my career and it is gratifying to see the evolving role of rural medicine in helping us to understand population health.

What current research projects are you working on?

I am working on a wide range of projects primarily on social accountability in medical schools. In particular, their accountabilities to rural communities. In addition, I am involved in a four university interprofessional and engaged project using watershed as the unit of analysis and looking at the health and environmental effects of resource extraction—specifically on the health of rural women and children. I am also co-chairing a global consensus initiative on social accountability and accreditation—to a great extent a follow through of the Global Consensus on Social Accountability (GCSA) and the 2017 World Summit on Social Accountability that I co-chaired in Tunisia. Several other smaller initiatives also fill my days—and my heart.

What are some upcoming global health projects related to rural medicine that you will be involved in these next few months?

In terms of global health, one I can think of is a specific project which has been the development (and evolution) of a national, public medical school located in Nepal where I did the initial feasibility study in 2004. Its focus is on rural and lower caste health. I have been closely involved with this project in terms of it coming into being and we have our third full class of graduates practicing in rural areas in Nepal. It has been a work of love from conception to execution.

Next week, I will be hosting the founding vice chancellor of that medical school who has been asked to establish a university. Its focus will be on the development for folks interested in providing public service through the reflection of values such as capacity building, developing the right skills and attitudes to ensure Nepal is able to steer towards an effective future.

Some of my previous global health projects occurred in East Africa and Indonesia. In Canada, I chaired the accreditation systems for medical schools both in undergraduate and professional development. One of the major projects I am working on now indirectly linked to global health is an appreciative inquiry on how social accountability has been adapted and expressed in medical schools here in Canada. There will be publications of that research in the next few months. At a global level, I have been co-chairing with Charles Boelen an initiative to develop a consensus paper on the role of accreditation in advancing social accountability.

In 2010, Charles and I co-hosted a Global Consensus on accountability in South Africa in efforts to describe and reach a global consensus from all regions of the World Health Organizations on what a social accountable medical school should look like. In 2017, we co-hosted a World Summit in Tunisia to develop an action plan to move forward in animating social accountability. In each of those places that I have worked, teams collaboratively try to establish a consensus on the basis of research methodology such as using a Delphi process for the global consensus to erect the best evidence towards the formation of these joint efforts.

The inequitable health status of rural is pretty universal. Since the principles of social accountability apply not only in medical schools (and other professional schools), there is also a responsibility to focus their attention on the health needs of the population they serve who are at negative variance in the health status of the dominant or majority of the population. When I did my initial studies in Nepal, for example, there was a 20 year difference in life expectancy in populations residing in the Katmandu Valley and the rest of Nepal. As the Prime Minister at the time indicated to me, if we do not fix that, a Civil War (which had just ended) would resume. In British Columbia, there is a two year difference in life expectancy which is equally unacceptable. The evolution of social accountability at so many different levels has required research methodologies to help give direction and rural is central to that.

What inspired your interest in rural health research?

What animated me was that I grew up in ‘the bush’ in west of Edmonton where my graduation class was about twelve people. I married a wonderful woman who grew up in a small town in South Carolina and when we decided we were going to have children, we went into a rural area to raise them and to practice. That has worked out very well. We lived in rural for about 17 years before we moved to the university. At the rural scale, you are able to study complex systems of care much easier than an complex urban setting. The RCCbc ethos (and also where my focus has been) is that urban has much to learn from rural. If I can be said to have an organized, academic philosophy, it would related to complex adaptive systems. And so that is a theory in which a rural scale is embedded and more accessible to study.

You made a comment on how urban has much to learn from rural, do you think rural health specifically in the local context of BC and Canada has much to learn from global health through collaboration and engagement with the international community?

The short answer to that question is yes. Global health looks at the global causes of these health disparities and tries to address them. Partly just by virtue of the fact where many (if not most) lower/middle income countries are primarily rural. And to me, where the interest lies is in reciprocal learning. Because we have consistently disadvantaged rural. There is a ‘hidden curriculum’ that has been well studied that has built prejudice and marginalizes of rural as a desirable place to learn, live and practice. On the other hand, there are other countries where development of primary care that valorizes rural care and supports it have been successful.

I have had the privilege to work in global health projects in places like Nepal, Vietnam, Indonesia and Uganda in developing the rural education portion of the curriculum there. All of this to me is a natural connection between the global concerns and local impact on policy decisions. One of my projects that received a large grant earlier from CIDA (https://www.who.int/workforcealliance/members_partners/member_list/cida/en/) was working on poverty reduction in Vietnam. The five year project involved six universities in which two were Canadian (one was UBC). I learned a tremendous amount there that directly influenced the Northern Medical Program here. As we did the engagement process in Vietnam, I was asked by the Dean  to be involved in the development of the Northern Medical Program and as Department Head, I helped develop the post graduate program and encouraged the undergraduate program in the North that was informed by the experiences I had in Vietnam.

Another thing I will be doing at the end of this month is doing field work in New Brunswick. One of the first large grants I got after finishing my term as a Department head in 2008 was the million dollar grant looking at collaborations at UNBC, University of Guelph, and an entity at Universite de Quebec a Montreal called Symbios where there is an ecosystem approach to health. We developed a full community of practice that has now matured into a very active collaboration with nine universities. It is multidisciplinary, focused on equity, and other characteristics to address the fact that rural, resource-dependent (particularly aboriginal women who reside in these areas) communities are placed with increasing environmental and social marginalization and risks.

Do you have any tips for new researchers who are new to conducting research?

To get into research, it is important to understand what science is for and what it is. I think we humans are born curious. If we are able to not only maintain but refine our curiosity, we will serve our society best. Research at its base is “organized curiosity”. The assumption that policymakers or others may have is that science gives us truth. In fact, it took a playwright to remind us; "The aim of science is not to open the door to infinite wisdom, but to set a limit to infinite error.” -Bertolt Brecht in The Life of Galileo (1939)

So the function of science is to be organized in your curiosity and that is a different stance than that thrown at us in high school and university—in fact the answers aren’t in the back of the book—or under a rock. Be curious. Because to develop your career in research requires developing the skills of organized curiosity that allow you to disprove hypothesis or test them to the point where stakeholders such as a policymaker who is looking for advice or an institution that wants direction in its priorities can be informed which directions might be most promising, through rigorous findings in research.

As you move down the path (i.e., ‘you’ as in society and ‘we’ as in the scientific community), there will be a need to work together to understand whether we are achieving what we thought we were going to achieve. Using research to address inherent skepticism rather than assuming it to be a truth seeker will help us challenge how we build the future of our society.

Thank you again Dr. Woollard for sharing with us your experience working in rural health on both a national and international scale. We look forward to learning more about the ongoing projects you are involved in and watching it develop. I would like to leave this last question for something fun.

If you won the lottery, what is the first thing you would do?

After I had gone to university, I had difficulty deciding what I wanted to pursue where my choices were either Chinese History Philosophy (which I had a scholarship in) or accept my admission to medical school. I had no idea what I wanted do. I was 18 at the time and had to make my decision by noon. I asked a friend who was shooting pool at the time what I should choose. And he said, “Well, if I make this shot, you’re going to medical school. And if I miss it, go take history.” It was decided when he made that shot.

Another little fun fact. I am living on the top story of a three level duplex and my grandson was born on the first level of the duplex. I get up every morning and have my coffee in the room he was born in. So to answer that question, I already won the lottery. From growing up as a poor boy from the bush in Alberta, I had already won the lottery a thousand times over. That is one in many examples of the good fortune I had. It is also an affirmation of how capricious life is. But if you grasp it passionately then, as Dicken’s put in the mouth of Mr Macabar: “Something will turn up”.