The Other Side of the Table

Sunday, September 20, 2026

I arrived back in Oxford late in the evening by bus from London. My Airbnb host was having dinner with her son and his girlfriend and offered me some mushroom risotto. I initially declined, but she insisted that I join them. What I thought might be a small taste turned into a full portion, followed by homemade tiramisu, raspberry truffles and rooibos tea with oat milk. It was a warm welcome back to Oxford.

 

One of the things I underestimated when I started this programme was the adjustment involved each time we move between modules. When I am back in Montréal, everyday life moves back into the foreground: work, different roles and responsibilities, and everything else going on at home. Oxford moves more into the background.

 

Except this time, it hadn't really. In the weeks leading up to Module 6, we had an online module on observational studies. I was also working through the requirements for my dissertation ethics application, doing the pre-readings for the upcoming module, and juggling various work and other deadlines back home. It was quite stressful.

 

But once I arrived, it was surprisingly refreshing to be back. Being in Oxford puts me in a different headspace, surrounded by conversations, ideas and perspectives that make me think more broadly than I always have the space to do in everyday life back home.

 

Monday, September 21, 2026

I stopped by Somerville College to meet Em from the communications team. I had recently written a photo essay for the college, and it was nice to finally put a face to a name after communicating by email. We caught up over tea in the common room, in proper teacups, of course, and Em showed me the piano in Flora Anderson Hall before I headed over to Saïd for the start of Module 6.

Monday’s enrichment talk began with a dissertation check-in. With our proposals due soon, the advice was familiar but increasingly relevant: keep the scope manageable. We have six months to complete the dissertation, and a focused project done well is better than an ambitious one that becomes impossible to finish.

We then moved into healthcare business cases, something I had not had much exposure to before. I found the distinction between a good idea and one that can be implemented interesting. Something can represent good value for money and still be unaffordable.

During a break, Dominik and I returned to an idea we had been talking about since Module 2: performing together. The problem was that Dominik is a bassist and I am a vocalist, so we had always been missing a pianist or guitarist.

With Cohort 5 arriving this week, I had asked Laura Davison, our recruitment manager, whether there happened to be anyone musical in the new cohort. A few days earlier, she had introduced me by email to Julius, a neuroradiologist based in Germany who also happens to play piano and violin.

After class, Mike invited us out for dinner, and Sami, Bren and I joined him for pizza and then gelato.

 

Tuesday, September 22, 2026

We filled the classroom with our usual international snacks. With the Mid-Autumn Festival coming up, Bell and I had both brought mooncakes to share. Bell had ordered traditional ones from Hong Kong, while I had custom ordered homemade ones from a friend's father in Montréal, in flavours including matcha, white bean, almond and sesame. Bahaa brought fresh dates picked from his trees in Egypt, while Mareli and Chryssy brought South African koeksisters.

The module opened with Apostolos Tsiachristas (Apo) and Gugulethu Moyo (Gugu). Apo introduced an analogy he would return to throughout the week: the health system as an engine. Before trying to fix anything, we need to understand how the engine works and where it is leaking. Fixing one leak can simply create another somewhere else.

We also discussed health policy, where one phrase kept coming up: context is king. A policy can make perfect sense on paper and still fail when it meets the place where it is supposed to work. This immediately made me think about northern Québec. In one of the communities where I stayed, I found a food guide on the fridge. It showed Inuit people sitting together on the floor with ulus, eating traditional foods alongside... broccoli.

There had clearly been an effort to make the guide reflect the local community, but some of the assumptions about a healthy diet seemed to have travelled north unchanged. When fresh produce has travelled thousands of kilometres, can be expensive and may not reflect what people locally choose to eat, simply putting broccoli beside traditional food does not necessarily make the advice locally relevant.

The session I had been most curious about came later that afternoon with Michael Kidd. The room was packed with both Cohorts 4 and 5 as well as others from Nuffield. He spoke from an extraordinary breadth of experience about leading through multiple health challenges at the same time. I was particularly interested in his discussion of Indigenous health and Indigenous-led reconciliation. Our role is to listen, learn and follow their lead.

Cohort 5 was starting their programme during the same week, and for the first time our two cohorts overlapped. After class, we had a networking session in the clubhouse.

I met Benoît, who is doing his DPhil at Nuffield and works in public health at the CHUM in Montréal. One of the physicians I had worked with in Kuujjuaq turned out to be his medical school classmate.

I also met Syena, a plastic surgeon at the University of Toronto who works with Indigenous communities in Nunavut and Northern Ontario. We spent the entire lunch discussing our work.

During one of the breaks, another member of Cohort 5 said hello. He asked if I was Chinese, and when he mentioned that he had done a degree in China, we ended up speaking some Mandarin together. I only realized afterwards that he was the Director General of the Ministry of Health in Somalia.

By then the jet lag was catching up with me. I had already turned down dinner with Cohort 4, but then a few members of Cohort 5 threatened to kidnap me for theirs. I ended up at the same restaurant, at the exact same table, where our cohort had eaten on our second day exactly one year earlier. It felt full circle. A year ago, we had been the new cohort. Now it was their turn.

 

Wednesday, September 23, 2026

Wednesday began with the social determinants of health and a challenge to keep asking why. If one fish is sick, look at the fish. If many fish are sick, look at the water. Rather than simply identifying a determinant such as employment, we were encouraged to keep looking outward at the structures that created those conditions in the first place.

Again, my mind went to northern Québec. We talk a lot about individual choice, but choices also depend on what options and circumstances are available. Educational opportunities may be more limited locally, while pursuing other paths can mean leaving your home community and support system for years. If we want more local people represented across the healthcare workforce, including in professional and leadership roles, there need to be realistic pathways for them to get there.

Sandro Demaio from WHO then took the systems thinking further. Many of the forces shaping health sit outside healthcare altogether: housing, transport, income, food and education. As doctors, however, we already think in systems. We move from the nephron to the kidney, from the kidney to the cardiovascular system, and eventually to the whole person. A kidney doesn't walk into the clinic. A person does.

The challenge is to keep moving outward. Sandro spoke about arriving in Mongolia with assumptions about what the major health priorities would be, only to discover that the reality on the ground was different. Something that seems irrational from the outside may make considerably more sense once we understand the system around it.

Photo credits: Fisher Studios

That evening, both cohorts joined some of the faculty for a formal dinner at St Peter's College. Shona Nicholson from Nuffield, a fellow Canadian, even came over to make sure I knew that this was Prime Minister Mark Carney's old college.

Since this was the only time our two cohorts would overlap, we raised a toast to Cohort 5, shared a few survival tips, and officially passed the baton.

 

Thursday, September 24, 2026

Thursday's standout session for me came from Francis Ayomoh from Nigeria's Ministry of Health. He had just sat an exam for his own promotion, flown back to Oxford and arrived that morning to teach us. When David offered him coffee, he declined, joking he already had his Coke Zero.

Much of the discussion centred on what happens when donor funding disappears. Foreign aid has saved lives, but it can also shape national priorities and create systems that are difficult to sustain once the money is gone. A Ministry of Health still needs to decide what to protect, what it can afford and how to keep the system functioning.

Even universal health coverage was more complicated than I had appreciated. Being technically covered means little if the care you need is unavailable or still creates significant financial hardship.

That afternoon, we had to put some of this into practice in a policy design lab. Our group was given a Nigerian vaccination case and asked to develop a policy response. The problem sounded straightforward until we began working through the system around it. We eventually presented our proposal through the people affected by it. I played Mary, a mother who had done what the health system asked and brought her child to be vaccinated, only to find that the clinic didn't have the vaccine.

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After class, we joined an “Uncomfortable Oxford” tour, which took us around the city while exploring some of the more difficult histories behind its institutions and achievements. We heard about medical advances alongside the uncomfortable question of how some of that progress was made, and at whose expense. We cannot change how we got here, but we can learn from it and think more carefully about how we move forward for the generations that follow.

Afterwards, a large group of us went out for Japanese food. Our table ordered sushi and I had a bowl of ramen, very kindly treated by Matt.

 

Friday, September 25, 2026

Friday opened with a discussion around partnerships, and the idea that a partnership is not inherently a good thing. What mattered more was understanding what each party wants, where power sits, what each side brings, and whether working together creates genuine value.

The idea of trust came up as a cost-saving measure. When partners know that people will follow through, communicate honestly and even simply pay each other on time, less energy needs to be spent protecting against everything that might go wrong. Partnerships also change over time and, at their best, can change the people and organizations involved in them.

Trudie Lang showed us that equitable research partnerships are not simply about including people from different settings. They also require us to think about who defines the research questions, who develops skills through the process, who has control over data, who participates in analysis and leadership, and who ultimately benefits from the knowledge produced.

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Just before lunch, Faris walked in with a large mosaic he had commissioned in Jordan months earlier as a gift to the programme. At its centre were the words: “Knowledge unites what distance separates.”

In the room that morning were people from all the cohorts: Munad from Cohort 1, Isra from Cohort 2, Alice from Cohort 3, Sadia and me from Cohort 4, and Izel from Cohort 5.

Photo credit: Joanna Francis

After class, I went shopping with Hashem for gifts back home. At the cheese counter, my first impression of Cornish Yarg was that it tasted a little like Babybel, and I wasn't convinced. Hashem persuaded me to keep it, and I'm glad he did. I also bought Kidderton Ash, mature cheddar, smoked Applewood cheddar and Black Bomber. I wondered how I was going to fit all of this into my cabin bag.

Hashem and I parted ways at Saïd, and I ran into Bahaa, his wife and daughter, and Mareli at the bus stop. We travelled together for part of the way before going our separate ways. I spent my final night at the airport hotel before flying home the next morning.

Looking back

This module gave me a new appreciation for what healthcare policymakers and leaders are trying to do. It is easy from where I sit to see a problem and wonder why someone doesn't just fix it. As a doctor, I see the needs of my patients and the parts of the healthcare system that affect them. As citizens, we all have things we think our governments should prioritise. But the people making those decisions are hearing all of us at once, while balancing limited resources, competing priorities, politics and everything else going on around them. I came away with more sympathy for the people sitting in those seats.

We kept coming back to the importance of speaking each other's language. That doesn't mean we have to agree. But perhaps we need to understand what someone else is trying to achieve, what pressures they are facing and why the answer that seems obvious from where we stand may look very different from where they sit.

I still want to make things better. If anything, Oxford has made me think much bigger about what might be possible. But this week reminded me that doing that well takes time, and that I still have a lot to learn. Perhaps that is part of learning to lead.