Bob Woollard, Associate Director of Rural Coordination Centre of BC
“Dr Woollard completed two terms as Head of the Department of Family Practice, Faculty of Medicine at the University of British Columbia. He has chaired senior committees, councils and task forces for the BCMA CMA and CFPC in the areas of medical education, environmental health and ethical relations with industry. He was CoPI on a large IDRC grant developing a community of practice in ecosystems health and has provided leadership in a number of major initiatives grant-funded through the Science Council of British Columbia, the Tri Council Research Fund, CIHR and a Major Collaborative Research Initiative with SSHRC. He works extensively in the issue of the social accountability of medical schools and is currently actively involved in a national medical school founded on these principles in Nepal—a school based on a feasibility study he conducted in 2004. He is also working in East Africa on social accountability, primary care and accreditation systems. He has completed a five-year, five-university project on localized poverty reduction in rural Vietnam.
He has chaired senior committees, councils and task forces for the BC Medical Association, Canadian Medical Association and the College of Family Physicians of Canada in the areas of medical education, environmental health and ethical relations with industry. His primary research focus is the study of complex adaptive systems as they apply to the intersection between human and environmental health.” – Linkedin (more here: https://ca.linkedin.com/in/bob-woollard-b75b8a2b)
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”.
David Snadden, Rural Doctors’ UBC Chair in Rural Health, Prince George BC.
"David Snadden is a graduate of the University of Dundee in Scotland and was a full-time rural general practitioner and family resident trainer for 11 years in the Highlands of Scotland. Following further academic training at the University of Western Ontario, where he completed a Master’s degree in Family Medicine in 1991, he returned to Scotland and became Senior Lecturer at the Department of General Practice, University of Dundee. During his time in Dundee he helped develop the first integrated postgraduate and undergraduate Department of General Practice in the UK and also completed his Doctoral degree, his thesis explored the use of learning portfolios in general practice training. He became Director of Postgraduate General Practice Education in 1996 and jointly led the integrated department until 2003. David also worked with the teaching hospital sector as Associate Postgraduate Dean where he was responsible for the first year of general residency training, some specialty programs and fitness to practice issues.He is a Fellow of the Royal College of General Practitioners, a Certificant of the College of Family Physicians of Canada and a Fellow of the Royal College of Physicians of Edinburgh. David joined the Northern Medical Program in July 2003 to lead its establishment and development. The distributed medical education model developed in BC was innovative and helped shape similar changes across Canada and internationally. In 2011 he was appointed as Executive Associate Dean Education in the Faulty of Medicine and was responsible for all the educational programs in the Faculty across the Province until his term finished in June 2016." - UNBC
More about me here!
Thank you for joining us this month to talk about your work in rural health across the province. How did you come to get involved with RHSRNbc/RCCbc?
As Rural Chair I work closely with the RCCbc.
What research projects are you currently working on?
Currently, I have various projects ongoing but some of my main research projects include:
- The Partnering for Change 2 study: This is a study that is examining the processes of Primary Care Reform in Northern BC. The study is examining the “how” of the reform processes and the partnership between Northern Health, health care staff, including physicians, and communities. Changing health systems is a long process and publications from Partnering for Change 1 are in process, and the current study is just starting and due to run for at least three years.
- Developing a Hermeneutic Approach to Implementation Science: This is a SPOR project and is just starting. Both this and the above study are led by Martha Macleod, Northern Health / UNBC Knowledge Mobilization Chair.
- I am just completing a project with Australian Colleagues which was a review of Australian and international approaches to family medicine residency training there which focuses on informing a reorganization of Australian residency programs.
- I am also a part of the CIHR Funded national Early Career Primary Care Physicians in Canada project led by Ruth Lavergne at SFU.
What inspired your interest in rural health research?
I started off as a rural family physician in the Highlands of Scotland and have always been intrigued by the way rural communities and health professionals deal with the problems they face through innovative solutions.
In your opinion, why is research important in the rural health context?
Rural communities, wherever you go, have poorer access to health care, yet rural health care workers are some of the most highly skilled I have come across. Research in general follows the same pattern where the rural elements are often excluded and consequent research findings do not translate well to rural. Rural has much to offer society in general in terms of how to deliver of health care and also has significant issues to overcome that are not necessarily relevant in urban areas. There are lots of opportunities in rural setting to engage with research and lead research that will help rural health care.
Do you have any tips for members just getting started with research?
The modern research environment is complex and there are certain processes such as gaining ethics approval for any study that must be followed. It is hard to start the research journey alone so look for help such as that provided by the RCCbc or the RHSRNbc to get some tips on how to get going.
What are some important elements to consider when conducting research?
Ethics is important as is funding, as even small studies need some resources. The most important thing is to take advice at the beginning on study design and what you are hoping to achieve and see if there is anyone with research experience you can collaborate with.
What are some of the obstacles you had faced when conducting research and how did you overcoming them?
Research is more fun when in collaboration with a multidisciplinary team. Having people you work with over a period of time is the best way to overcome obstacles like funding and how to effectively design a study. In my early research career I found formal training to be a great help as well as it helped me understand various methods better.
Getting to the fun stuff now, what is your favorite indoor and/or outdoor activity?
I like being in the mountains, whether it is hiking or climbing in summer or backcountry or cross country skiing in the winter.
If you won the lottery, what is the first thing you would do?
I would figure out how to give most of it away – probably through setting up scholarships for underprivileged students to pursue health careers.
If you could go back to any year in time, which one would you choose and why?
Probably the turn of the century when I was more fit and active than I am now, and when the world was a much safer place to travel in.
What is one fun fact about yourself?
For someone who loves rural environments I was born and raised in big cities – Mumbai and Singapore.
Thank you Dr. Snadden for joining us on this month's Spotlight Feature!