Profile
Dr Catherine D'Souza on rural palliative care
Timaru's sole palliative care specialist reflects on going it alone, rural leadership and the colleagues who keep her going.
RACP – Kia ora, Catherine and thanks for making time to talk to us as part of Aotearoa NZ Specialists Week. Could you tell us a bit about yourself, your background and what you do?
Dr Catherine D’Souza – I am originally from the UK and had my first consultant job at Oxford University in the Palliative Care unit there. I came to Timaru in 2018, which was a big change coming from a huge tertiary referral hospital to a small rural area. I am married with two children.
What got you interested in medicine and more specifically in your specialist area?
I initially wanted to be a psychologist, then through some volunteer work experience with homeless people I decided I wanted to work in Psychiatry and mental health, as I was very interested in how people tick and how I could help them psychologically. However, I found that I had more of an interest in doing that through Palliative Medicine, than through Psychiatry.
I also enjoyed every specialty area that I worked in, such as surgery and the medical specialties, but I wanted to work in an area where you were involved in everything about the person, not just a short interaction, or about a particular part of the body, so Palliative Medicine was a brilliant way of caring for a person and making a big difference to them and their whānau.
"Palliative Medicine was a brilliant way of caring for a person and making a big difference to them and their whānau."
How did you end up moving from Oxford to Timaru?
Well, I got a job offer out of the blue. I hadn’t applied for anything, but somebody had got my details from another palliative care unit in Nelson where I had been previously looking at jobs. When I received the job offer I had just done a 3 hour commute through London traffic, and I thought a move to New Zealand sounded like a good idea. It was never meant to be permanent, as I just wanted to come over and see what the other side of the world was like, have a bit of an experience while the kids were young and maybe move back, and then I didn’t move back.
How is the experience living in Timaru?
It’s great! Everything is so easy, there is no traffic, I pretty much cycle everywhere, I cycle to work, cycle to get the kids from school, so I have much more time with the kids being in a small town as opposed to being in a big city where I would spend an hour each way commuting to work. Another benefit is that I know all of the doctors here, so referrals and interactions with other consultants is just so much easier, same with the GP’s.
What are some of the challenges you face working in a rural setting?
There are some obvious workforce challenges, as here I am the only palliative care specialist, and they hadn’t had a consultant in palliative care before I arrived. Also, we are working with about half the number of RMO’s that we should have, so that spreads everybody very thin.
When I first came here there was no out of hours cover for my inpatient unit, so I was pretty much on call for the first few years until we could set up an on call rota. However, the benefits of really being able to get to know your patient cohort, know the communities they live in and know who to call to get help is a brilliant asset of being in a small community. This in turn creates a greater degree of flexibility in what you can do for people. In some of the bigger units I have worked in you are often trying to get through a system to find someone to help you, whereas in a smaller setting we have more collegial ways of getting on and getting things done.
Another challenge we face is the difficulty of taking leadership opportunities when you are based in rural settings. Due to the smaller size of teams and the broader range of responsibilities, it is so much harder to get away from work, and at the same time it takes longer to travel to places such as Auckland for key meetings etc. Because I come from a big centre I am used to taking on leadership roles, but I have noticed you do tend to get treated differently if you are from a small place, or assumptions are made about what you may or may not be interested in.
"In some of the bigger units I have worked in you are often trying to get through a system to find someone to help you, whereas in a smaller setting we have more collegial ways of getting on and getting things done."
What does a typical day look like for you?
I work in a multitude of settings, so I work in a hospice in-patient unit, and I usually start the day by getting a handover of how my patients have been overnight. Then I might move straight on to an outpatient clinic or move straight over to the hospital to do some liaison work in between seeing patients on the general medical or surgical wards, then I might head out into the community to do a home visit. I spend a lot of time taking advice from other specialties, such as medical consultants, surgeons, GP’s, nurses etc, I am on the phone a lot to them.
I also do a lot of teaching with local doctors, junior doctors, medical students and also teach in the care homes with nurses. I also teach carer skills courses, which shows carers how to look after people who are terminally ill, and I also teach a breathless less management course.
Do you have much to do with AI or tech applications in your work?
Not really. I don’t use any AI for note writing support, as I have a support staff member that looks after that.
What do you do to get away from your work or maintain a good life work balance?
When you have two young children you need to take time out to manage family life, so they absorb a huge amount of my after work life, and that is wonderful, so a lot of my hobbies involve my children as well. I am in a beautiful area of the country, and I am a keen cyclist, so I participate in an annual 360 km sponsored charity bike ride over three days, which is fun and keeps me fit. I also cycle to all my home visits!
What gets you excited in your day-to-day work?
I have an amazing team at the Hospice, and it is a cool place to work. I enjoy being part of a very caring and supportive environment, which you don’t get at a lot of workplace environments. The job I do, which involves some quite challenging circumstances and emotions supporting people through difficult times is tough, but by having a wonderful team who bring light and laughter to people and their families is a real joy.
Does the nature of your work take a toll on you personally?
I think sometimes. When I was in a single handed medical team, and did not have medics in the team, I felt the toll of responsibility being in charge of very complex medical and emotional situations. It definitely requires a really strong team to support each other to keep you going and I am grateful for the team I have here.
Thank you so much for your time today.
No problem at all.