Meet Our Team
Q&A with Dr. Megan Doherty
Dr. Doherty – a palliative care specialist at CHEO, in Ottawa, Canada – is the recipient of the Canadian Palliative Care Physicians 2023 Humanitarian Award. She is a Two Worlds Cancer volunteer and director, and is our Sunflower Children’s Network pediatric palliative care director.
Photo: Sandra Broughton/Two Worlds Cancer
What is your role at CHEO?
I'm a pediatric palliative care physician at CHEO in Ottawa and I'm the director for our residency program. And I’m a palliative care specialist at Roger Neilson House [children’s hospice]. The physicians on the palliative care team from CHEO also provide clinical palliative care for the children who are admitted at Roger Neilson House.
I've been a physician at CHEO since 2008 and I've been a palliative care physician there since 2013. We've had a pediatric palliative care residency program for two years. And so I've been the program director of that program. I was involved with getting it started four years ago.
What does receiving the Canadian Palliative Care Physicians 2023 Humanitarian Award mean to you?
I'm very honoured. The work that I do couldn't happen alone. This award obviously goes to a physician but I always feel like it's a little bit artificial to say, “Oh, it's this person,” when really it represents the fact that there's a team, a lot of people coming together to do this work. For me what the award represents is all the work of Two Worlds Cancer Collaboration for the past few years along with PallCHASE (Palliative care in humanitarian aid situations and emergencies) and my time with World Child Cancer.
It's a chance to raise awareness and say, there are big gaps and you can help fill them. You can volunteer, you can be part of this work that builds capacity. There's a place where you can find this level of involvement and fulfillment – and it is very rewarding. There's obviously many more adults who need it, but pediatrics and children’s palliative care is a group that's more hidden within palliative care.
How did you start in medicine and palliative care?
I just was drawn to it. First I thought, I want to care for children with cancer, be an oncologist, and then realized I really want to really understand patients and their families. Really holistically look at how they can have the best quality of life, and realizing that for me that wasn't actually oncology, that was palliative care.
I love it. It's such a team-based approach. It's really taking different skillsets that different professionals have and bringing them all together. And I really like seeing the child and their illness through the lens of they have a family and a community, and they exist in the wider world.
How long have you been with Two Worlds Cancer? And what brought you to Two Worlds Cancer, or who?
I've been involved with Two Worlds since 2017. It was actually quite a chance encounter with Dr. Robin Love in the airport in Pune, India and somehow we got in the same taxi to the Indian Association of Palliative Care conference. The rest is history, I guess. I was living in Bangladesh then. Robin really told me what the organization was about. Hearing that it was a Canadian organization with a focus on South Asia, it was really a natural fit for me as someone who was working in that region and really working on the same issues.
When you were working in Bangladesh, you were working with World Child Cancer, is that right?
Initially when I moved to Bangladesh in 2013, I had already met with World Child Cancer before I went. They had a project running on childhood cancer that needed someone to bring in palliative care. So I was able to do that for them and be very involved throughout my time in Bangladesh with that project and Bangabandhu Sheikh Mujib Medical University (BSMMU). I was working on the initiatives that they identified as priorities under the supervision of the project lead who was a pediatric oncologist at BSMMU.
How would you describe your role with Two Worlds Cancer?
I see my role as a catalyst and as someone who brings expertise in pediatric palliative care and how to care for children. And it's bringing in people who can form a team with the teams in South Asia, working together on shared priorities that we identify together, that we go forward with together. It's about long-term relationship building because that's how capacity building happens, that's how the clinical work on the ground changes and evolves and improves over time. So our partners feel that there's a lot of trust. It's just a sharing and a mutually building off of each other's experiences.
What’s your vision for the Sunflower Children's Network?
My vision is to see a partnership and group of organizations that work together under the umbrella of the Sunflower Children's Network, catalyzed by Two Worlds that enhances, builds, and delivers new and improved palliative care initiatives for children with serious illness across South and Southeast Asia.
You are involved in many organizations as well as Two Worlds Cancer, you are a huge advocate for humanitarian palliative care and you have been involved with PallCHASE, why is that?
I have been involved with PallCHASE (Palliative care in humanitarian aid situations and emergencies) since quite early on. Looking back, what drove that was the Rohingya crisis. And I was lucky, I was well-placed with my colleague Dr. Farzana Khan to be the one who went [to the refugee camps].
That was the first time there was an event that really brought a lot of people to the table together to say this is a big crisis happening. And these crises happen all the time and there's many hidden ones that hardly come onto the international radar, but the Rohingya crisis just came at a time when a large number of the right people from different organizations came together and were focused.
PallCHASE has really grown. It’s a professional network, a place where people can connect and learn more about this issue. A big part of what it's done, is to say, ‘We don't need a new huge organization that does everything. We just need the right people to come together for each crisis and identify the needed resources and work together.’
Since you started with Two Worlds Cancer Collaboration, what do you see as successes?
I think a really big success of Two Worlds is that they’ve built a very strong committed group of individuals who work together for this shared purpose. And very interestingly, unlike many other organizations, this group of individuals is mainly volunteer. To have a highly committed group of people who donate that much time and energy and intellect to this organization is very powerful and continues to grow.
Where do you think that motivation comes from amongst healthcare providers?
I think just an awareness that around the world there's such a disparity in terms of the health services that people get. Particularly in palliative care, we see so much preventable suffering. We're not talking about things that are expensive or difficult to provide. We're talking about very simple, relatively inexpensive support that can be provided in the vast majority of health settings. The Lancet Commission in 2017 spoke to this as an “Abyss of access.”
It's a hidden problem and it's a deprioritized issue because when people are really sick they can’t advocate for themselves. They're not saying, "I need care," because they're too sick and their family is focused on caring for them.
How is the Sunflower Children’s Network helping to build healthcare capacity that helps close the care gap – that abyss?
I'd say that our Project ECHO online education and our fellowships programs are two pretty big successes in building capacity.
We were in really early with ECHO in terms of identifying that this could be pretty profoundly changing. And we've really leveraged that to reach thousands of health professionals, which is really the way you have to go, because the numbers are so staggering in terms of number patients that need support.
If you think about South Asia, home to 25 percent of the world's population, the number who are going to need palliative care is huge. So as individual healthcare providers, we're never going to see all those people. We can't care for them, we can't reach them. We have to have some kind of multiplier effect by training others who then can see all their patients through this lens of how can we address quality of life, reduce suffering, manage pain and ensure people have good care even when they're incurable.
The fellowships also have been really successful. You can speak to the quality in terms of the Royal College of Pediatrics [UK] showing this to other specialties and saying, ‘This is how you should be developing your fellowships.’
It's a team-based, broad-based approach that ensures that level of quality. We've got more than 30 specialists who volunteer time and teach. We have diverse sites across South Asia and the Philippines where our fellows are training and we're not just supporting them during their fellowship, we're also supporting them post-fellowship – early career mentoring and giving them further opportunities to build their leadership skills and clinical skills.
I see it as part of the whole ecosystem of education. We're developing and delivering a lot of educational programming through ECHO and I think the fellowship is so important because in many parts of the world, a specialist physician is this rare bird. They're a critical piece – like the keystone. Without them you can't build a broader palliative care system.
What do you think are the biggest challenges ahead for the Sunflower Children’s Network?
I think ministry of health buy-in, both at a political and bureaucratic, administrative level is always a challenge, because they have competing priorities. They're not just in charge of palliative care, they're in charge of all healthcare for the whole population. So it's never going to be the top issue.
Every part of the health system needs money and this is another part that costs money, even if it's relatively inexpensive, it's still hard if you're a country that doesn't have a lot in your health budget. I mean, we still struggle with all the usual palliative care problems [here in Canada] – Lack of awareness and understanding of how this can really help patients. It’s another barrier for sure.
Ideally, collaborations are a two-way flow. What have you learned from our partners or experiences that you bring back to your own practice?
So much. Everything I do in palliative care is better because of everything I do internationally. I have learned how to teach better, how to break down what I do into more operational steps, how to teach communication, how to help people who haven't had a lot of training to better communicate with children and their families. So I’ve learned a lot about how to teach better and that transfers back to all my work, because I teach my residents and fellows, and med students here better too.
I also have learned a lot more about all the skills around the edges of palliative care. In a health system like in Canada which has lots of different types of health workers and people with different levels of expertise in different things, you can be really narrow and niche. But then you go to Bangladesh and now you're seeing children with cerebral palsy who need palliative care, but there's no neurologist that they can see.
So I would say I'm much more knowledgeable about the other aspects of care for the types of conditions that I see than my colleagues in Canada typically are.
Is there an experience with a patient or family that really sticks with you?
When we first went into the Rohingya camps, it was very early days and people were just arriving. Children and families were just arriving with whatever medical issues they had. And I remember this little girl who had retinoblastoma, which is an eye tumor.
She was probably five or six. She'd had surgery to have the eye removed and then she needed chemotherapy. And she was not close to anywhere where they had chemotherapy. I remember the father saying, ‘Okay, we need to get to this big hospital where they can give the chemotherapy.”
Somehow they managed to get to the hospital but were told at the hospital we aren’t funded to help you, you just need to go home.
So that motivates me a lot to say we can do better. We don't need to send people on these enormous journeys and put all this hope in this thing that isn't going to really address what's the fundamental issue for them. And ultimately, she had an advanced cancer, so all of that wasn't going to be most helpful.
Mentorship is a huge component of what you do, and building peer networks. Did someone do this for you?
I think this is really important, because I didn't have those people early on in 2013 when I was starting out. It was really hard and I had to find my own way a lot, and I think make some missteps along the way, and course corrections. But I think being part of Two Worlds Cancer was a pretty instrumental part of my mentorship. That's where I started to really get guidance – from Max Watson, Stuart Brown, and Robin Love. Just in conversations with them about how they'd been doing this for many years, watching how they worked, observing them that's really how I learned a lot of what I now pass on to other people.
Palliative care is intense work. How do you cope with that emotionally?
The thing that really sustains you is seeing that you make a big difference. You’re surrounded by a lot of suffering, a lot of sad things, and things that you can't change. I think to do this work alone is impossible. You have to do it with a team and with support from each other. And then when things are hard, you have each other to debrief, reflect, and bounce ideas off.
At CHEO, it’s an incredibly strong palliative care team we have here and that’s been very much a support. And then, Two Worlds is a tight team and the teams we work with on the ground in South Asia, those teams also support me and support each other to do this work that really can be hard.
But if you weren't there, things would be worse for a child and family. So as much as the outcome may be death, it can be a death that that has minimal suffering, that has good support for the family. And that can make a huge difference for people.
What do you do when you switch your palliative care brain off?
I do switch the palliative care brain off. I'm very diligent – after hours on Friday until Monday I'm out. I'm not there. I coach my children's ice hockey and I play ice hockey myself, badly but I enjoy it. So that's the main thing I do when Ottawa is frozen. Then in the summers I just enjoy being outside at the lake, in the woods, in nature, in a calm, quiet environment. And totally cut off from all electronic forms of communication.