Ambassador for humanistic care

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“We thought it would be important to start our own medical school, so that’s what we did,” says Sister Monique Bourget, MDCM’92, Dip Epid & Bio’95.” (Photos courtesy of Sr. Monique)

By Sophia Blankenhorn

When Sister Monique Bourget, MDCM’92, Dip Epid & Bio’95, first arrived in Brazil 22 years ago, she was an anomaly.

I would introduce myself as a family physician, she says.

The problem? No one knew what that was. The specialty of family medicine did not have a strong foundation in the country.

That would soon change.

Sr. Monique worked to get family medicine recognized as an official specialty in the country. “I helped to build the exam that doctors had to pass to earn the title,” she says.

A calling

As a teenager, Sr. Monique travelled to Guatemala for a month of volunteer work. There, she lived with three sisters. “It was a very deciding time for me,” she says. “It was where I felt the call that I should dedicate my life to people who needed it.”

The order that she joined, the Religious Congregation of Santa Marcelina, gave the option of pursuing a degree. Sr. Monique applied to medicine at both McGill and Université de Montréal. She chose McGill, because it was able to accommodate a two-year absence, to Milan, for her religious training.

“When I joined the Order, I knew I would go to Brazil after finishing my medical degree, because that is where we had health care facilities with the greatest need.” To prepare, Sr. Monique travelled to Brazil several times during her studies “to get used to the language and further understand the health care system.”

During her time at McGill, Sr. Monique could often be seen biking through campus in her habit.

It wasn’t all work, though.

Sr. Monique has fond memories of playing intramural women’s hockey at McGill.

And those who knew her remember her biking across campus in her habit.

When Sr. Monique arrived in Brazil, the country’s Ministry of Health had just decided to initiate a family health program in São Paulo, a city of more than 11 million people. For help, they turned to her congregation. “The sisters were in charge of managing the program and because I was a family physician they thought I would be able to help to start and implant an effective Family Health Program in the community,” says Sr. Monique, who also has a master’s in Epidemiology from the Federal University of São Paulo.

This was the first time such a program had been attempted in a city of that size.

The plan was to assign health care teams composed of one physician, one nurse, two auxiliary nurses and a few community health agents to serve areas of 1000 households.

There were many obstacles to overcome.

“We started with only 11 physicians,” says Sr. Monique, adding that this kind of work was not initially considered very attractive by doctors. “But the nurses and the community health agents did a great job, and it just started growing. Now, the city has 1500 teams.”

In 1998, Sr. Monique helped open a new community hospital, Hospital Santa Marcelina – Itaim Paulista. She took over technical direction of the facility, which boasts more than 264 beds with practices in obstetrics, internal medicine, surgery, orthopedics, pediatrics and psychiatry.

Seven years later, Sr. Monique became medical director of Hospital Santa Marcelina de Itaquera, a teaching hospital with more than 700 beds. Sr. Monique also helped to start and continues to play an active role in the hospital’s residency training programs, which, under her guidance, emphasize humanization, social responsibility and palliative care.

Regarding palliative care, Sr. Monique says that one of her most affecting memories from McGill is of a lecture she attended on death. The speaker was Dr. Balfour Mount, Eric M. Flanders Emeritus Professor of Palliative Care, who is considered to be the father of the field in North America.

Sr. Monique also brought other lessons learned at home to Brazil. At Hospital Santa Marcelina – Itaim Paulista, she took an interest in obstetrics. “That was another big role I was able to play in Brazil, especially in São Paulo. Brazil has the highest level of cesarean sections in the world and a very interventional approach to pregnancy. Because I came from McGill and Canada, where there are a lot of natural births—and labour with the help of midwives—when I got here I was really shocked at the level of intervention. So I said if I’m going to change something, I’m going to change something in obstetrics.”

To effect change, Sr. Monique developed a friendship with the hospital’s obstetrician. “And he went to Canada to see how see obstetric practices differed, and he saw that what I had been telling him was correct—that there are more natural births.”

With the help of her new recruit, Sr. Monique worked to change practices in the maternity ward. “We had labour rooms, family could stay with the patients,” she says. “We had the lowest C-section rates in São Paulo and then more and more people came to visit, and a more humanistic approach to delivery became more popular.”

Sr. Monique feels that humanization in medicine is still a big challenge in Brazil, and, having made an impact on obstetric care, she is now seeking to do the same for end-of-life care.

“We were really able to change obstetrics care. I think that was another big role I was able to play in Brazil, especially in São Paulo,” says Sr. Monique.

Ties with McGill

Always seeking to do more for her community, Sr. Monique helped to start the hospital’s own medical school. “We thought it would be important to start our own medical school, so that’s what we did,” she says.

The school opened in 2012 and will have its first graduating class in 2018, with 110 students in each year.

Sr. Monique is also partnering with the McGill Faculty of Medicine. “On October 11, we are starting a course with McGill for the students working in family medicine here in São Paulo—I am very pleased.”

Over Homecoming Weekend in October, Sr. Monique will return once again to campus, this time, to accept the 2017 Medicine Alumni Global Community Service Award, presented, since 2009, to an MDCM who has made outstanding contributions to the betterment of our local or global communities.

No word yet on whether or not she will have a chance to bike.

 

 

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Comments

3 Responses to “Ambassador for humanistic care
  1. Dr Colin Forbes says:

    I knew Dr Balfour Mount- he was a real pioneer. Sr. Monique’s wonderful work in Brazil reminds me of the “Health Houses” I established in Kenya during my 43 years service there. God bless you Sister. Colin Forbes, MD.,CM, McGill 1955

  2. Catherine Ferrier says:

    Great choice.

  3. Michael Thomassin says:

    Wonderful story. Great choice.

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