Interview with Dr. Tunde-Byass
Vrati M. Meha, 2T5 WB
Dr. Tunde-Byass is a Fellow of both the Canadian and British Royal College of Obstetricians and Gynecologists. She earned her medical degree from the University of Ibadan in 1987 and completed her OB/GYN training in the UK followed by University of Toronto, Canada. Dr. Tunde-Byass has been an active staff member at North York General Hospital (NYGH) for 20 years. She is a leading expert in Early Pregnancy Loss and has received numerous teaching and innovation awards in the field of Obstetrics and Gynecology. Dr. Tunde-Byass is the inaugural president of Black Physicians of Canada and a co-founder of Women’s Health Education Made Simple.
Q: What inspired you to pursue medicine?
For as long as I can remember, I wanted to be a doctor. Although I was the second youngest of all my siblings, I was often told that I was mature for my age; I was caring, thoughtful, and I did well in school. I was also fortunate to have grown up in a loving home with support from my parents and siblings. All of these factors inspired and enabled me to go to medical school.
Q: How did you come to the decision that you wanted to pursue OB/GYN?
In medical school, OB/GYN was very well taught over two rotations in six months. I had devoted teachers who trained in the UK and Nigeria. We could excel in OB/GYN as we were exposed to clinical scenarios and performed as many deliveries as we wanted. Students in the program were required to work at both the teaching and community hospitals; between the two sites, we assisted with at least 60 deliveries. That was both satisfying, and competency building. I fell in love with OB/GYN during my foundational years, and the feeling has remained the same.
After medical school, I completed horsemanship in Nigeria with 3-month rotations in OB/GYN, pediatrics, general surgery, and internal medicine. I became a resident in the UK, where I developed the skills to manage very busy labour floors with 3000-7000 deliveries per year. We worked very closely with nurses, who were also midwives, and it was crucial to have that team approach. I was trained to care for and deliver high-risk patients, and it was all very interesting. Low risk prenatal care and deliveries were attended to by the midwives.
Q: Why did you have to go to the UK to train and then what brought you to Canada?
Post housemanship, I completed an additional year of compulsory training in Nigeria called the National Youth Service Corps. It was not uncommon for people to go abroad and acquire more training outside of Nigeria; this was the case for me in the UK. I got married there and had my kids. My husband and I continued to work in the UK. However, my husband found an opportunity in Canada and moved here to explore it.
I was a high-risk maternal fetal medicine fellow at King’s College, London. I moved thereafter to Canada. Interestingly, it was the year that Canada stopped recognizing medical training from the UK so my entire training was no longer recognized here. I had just missed that opportunity. My passion for the field was too great for me to stop, so, I was ready for the challenge, which meant I had to redo my residency. This part of my journey was very difficult as a mother of two young children. It was difficult to navigate the system. Yet, I couldn’t imagine not doing what I loved so much. It was a huge sacrifice, but I have no regrets. I received a lot of support from staff and colleagues who were respectful of my skills and experience. People were nice to me. Looking back, I am glad I did it, and this year marks my 20th anniversary of starting as a staff physician at North York General Hospital – a wonderful place to work.
“I love what I do still”
Q: Given that you have experienced working in so many different types of healthcare systems across the globe, what do you think we can learn from these other countries and their health systems? How can we do better?
I consider it a great opportunity to have, what I call, a global experience. I consider myself fortunate, and this has made me the physician that I am today. Training in a developing country, where technology was not always available, forced me to bedependent on my clinical skills. The training in the UK (i.e., the home of clinical obstetrics) prepared me for everything, and the icing on the cake was training in Canada, which afforded me the opportunity to be at my best.
Although, there were challenges along the way, it all added up to a positive life experience. The Nigerian and the UK systems are quite similar. The UK is a much smaller country than Canada, but it cares for a lot of people, and I found that, for the most part, the system worked well for patients. Patients couldn’t just ask for tests, and there is a long waiting list for appointments. The program in the UK really emphasizes early skill acquisition because you manage the entire floor with the consultant not being in-house. I learned a lot very quickly. However, the system is very hierarchical. At that time, it was extremely difficult to move up the ladder to become a consultant – a coveted position.
The Canadian system is different, and by the end of the five-year training program, we ensure all our residents can work as staff. Another difference: the UK has also always collected obstetrical outcome data. The Confidential Enquiry into Maternal Deaths collects and publishes information on maternal mortality and morbidity, and all trainees have used it as the ‘bible’ to learn from to avoid repeating the same mistakes. In Canada, we don’t do this. We also don’t collect race-based data here. I was quite shocked when I first learned that we don’t know which women die in obstetrics! Thankfully, we are now beginning to do this and having more conversations around the importance of race-based data. This will lead to heightened awareness of what needs to be done to move the needle forward and address inequities.
In the UK, you only had one family doctor (i.e., General practitioner orGP), based on your postal code. If you moved, your health records movedwith you to your GP’s “surgery” or office. This reduces doctor shopping and makes the system more accountable. The payor system is also a huge difference. This experience has made me realize that I can adapt easily and has allowed me to be the physician I am today.
Q: What inspired your interest in early pregnancy loss (EPL)? Could you please share your journey on developing and working towards this area of expertise?
My interest in EPL started in the UK. EPL care was establishmed in the late 1980s and early 1990s. As a junior resident in the UK, we were trained to care for and to perform suction dilation and curettages (D&C) for patients with EPL. At the time, if you could imagine, we were tasked with doing many D&Cs after hours, often at night, whilst managing the labour and delivery floor on our own. It was a lot for a junior resident.
The concept of EPL assessment came about to reduce the workload for junior doctors while allowing women to get care in a timely fashion by bypassing the Accident and Emergency (A & E) department. Prior to this, all the patients experiencing EPL and complications went to the A & E department. There were also no medical options offered to patients, like we do today. A significant number of women were treated surgically. Mifepristone was available but was reserved for management of medical abortion. We were trained to perform our own ultrasounds.
As a result, early pregnancy assessment clinics (EPACs) were introduced, and I really liked the idea of having a dedicated practice to help patients experiencing EPL. The EPACs took away that portion of your night from the emergency department. Patients could also self-refer to the clinic and get help for their symptoms without waiting in the A & E department.
Interestingly, my own experience as a patient also solidified my interest in EPL. During my first pregnancy (before EPACs were standard of practice), I showed up in the A & E with a threatened miscarriage and, of course, it was not in the daytime. The night was cold, and the wait was long. A cold speculum sent shivers down my spine. I still remember the experience to this day. I made a promise to myself not to examine anyone with a cold speculum.
Coming to Canada, I found that a significant number of patients experiencing EPL still went through the emergency department for care, and there were no dedicated clinics to care for these pregnant individuals. It was déjà vu! When I came to North York General Hospital, the chief of the department, the late Dr. Titus Owolabi, was very supportive and this led to the birth of EPAC at North York. We were the second site in the city.
North York General Hospital, where Dr Tunde-Byass has practiced as a staff physician for 20 years.
Q: What goes into starting a brand-new clinic at a hospital site?
Firstly,, we came up with a business plan to see twelve patients every half-day, three times a week. We reached out to our colleagues in the ED to gauge their interest, and they were open to the idea of a system that would support the ED and provide follow up care for patients undergoing EPL. EPAC started off in a small room with an ultrasound machine, a nurse, and five OB/GYNs Once you build a good system, people would come. The word spread like a wildfire in Harmattan. We became busy very quickly.
Yet, location is important! The clinic was initially situated next to the labour and delivery department. This was a huge mistake – lesson learnt! You don’t open EPAC next to the labour and delivery area. After receiving feedback from our patients and with lots of advocacy, we were moved to a different floor. Sometimes people ask, “Why don’t you send EPL patients to abortion clinics?” I tell them, “No… You can’t! You have to understand that a loss is difficult. You have to acknowledge the pain and anguish that people with EPL go through.”
Our initial data revealed a reduction in the number of reassessments in the emergency for ectopic pregnancies. EPAC provides a streamlined and compassionate approach to individuals experiencing EPL, and our patients are appreciative of this service. However, there is limited access to care. The clinic operates three half-days a week, which is insufficient. Unfortunately, access to care continues to be through the ED.
A clinic with daily access and after-hours service would bypass the ED and reduce the burden on the overstretched service. Unfortunately, it appears that women’s health is not a priority, so it takes a lot of advocacy to move the needle.
Dr. Tunde-Byass was recently featured in a CBC documentary on Black maternal health.
Q: Can you describe the process of moving from your original location to the new location of the clinic? What type of data did you have to gather to show proof that this change was needed?
We had to do a lot of negotiation to move, but patient feedback was very helpful. We also used the literature published on EPL care, and many studies clearly state that EPACs cannot be placed in or around the labour and delivery or abortion service clinics. I am very happy with the new space. EPAC is a teaching site for clerks, residents, and fellows in compassionate care for EPL.
Q: You are also the president of Black Physicians of Canada (BPC). What has this role taught you?
Being the president of BPC has taught me a lot! As you know, BPC is a national organization that was founded after the death of Mr. George Floyd by two residents – Dr. Hadal El-Hadi and Dr. Teresa Semalulu. I volunteered to lead the organization. I was very impressed by their vision and passion. My role is to help execute the vision of the organization. As a voluntary position, it requires a lot of time and resources. The work is interesting and intense. I learnt to work around my schedule while ensuring that my clinical work did not fall on my colleagues. I did not anticipate the intensity of the work. I had media training – thanks to Ms. Gaby Giroday. I took the new evolving academic leadership (NEAL) course over 9 months at the University of Toronto, which I would greatly recommend.
Q: In your leadership and mentorship roles, what are some of the biggest barriers do you think for indigenous and black medical students and what do you think are some solutions to removing these barriers?
Statistically and historically, these two groups are hugely underrepresented. So, we have to first acknowledge that we have a problem. Then, we would be ready to disrupt and dismantle racism. Think about the impact that racism has in these populations! Addressing racism and the inequities in our system benefit everyone. Increasing representation to serve the diverse Canadian population is important. Early mentorship is crucial so that these learners stay within the profession. Isolation, burnout, imposter syndrome, and excessive attrition are common in Black and Indigenous learners. Data from the United States shows that 20% of Black learners leave the program, despite representing only 5% of learners. A culture of wellness, compassion, equity, fairness, and social justice is key to raising healthy physicians. Finally, we need to support the next generation of physicians so they can lead. Current medical students, like yourself and others, have a lot of potential that needs harnessing for a better healthcare system. The time is now.
Q: What would be one advice you would give to the medical students reading this interview?
I would tell them that being a medical student is a privilege. You have worked very hard and made sacrifices; therefore, you must enjoy everything about this profession. Work-life balance is crucial. Avoid putting off things that matter to you. There will never be a right time to travel, start a family, or spend time with loved ones. Challenge the status quo and be part of a transformational change for good. Be an advocate for your patients, and be ready to learn from your patients.
