insight + views
Blog by Dr. Z
Gender Equity: The Struggle is Real
As a female family physician, my patient demographic is over 70 percent female. Over the last two decades of practicing family medicine, I increasingly see female patients with chronic illnesses, chronic pains, autoimmune disorders, cancers and caregiver burnout including anxiety and depression. You may think that is just my experience, but sadly, a social determinant of health is being female. The stressors and societal expectation of women, to be everything to everyone including the glue of our society, is clearly not serving us. Yet, I am conflicted on how we can care for ourselves as women while operating within patriarchal societal norms to advance female leadership in gender equity.
An example of this struggle is highlighted throughout the last twenty years I have practiced medicine. Becoming a mother of two girls, I’ve had my fair share of burnout, anxiety, and depression, to the point that I wanted to make a drastic change and quit practicing medicine altogether. I refused to take on any leadership roles for a long time and blindly carried the load of both work and home life because it’s the expected societal norm for working women to do it all without ever asking why society considers this as a norm in the first place. In fact, whenever I was offered some help from my loving partner, it was in the form of ‘how can I help you fulfill these responsibilities’, not so much what I needed in asking ‘how can we divide and conquer the responsibilities’. I accepted my gendered roles and struggled silently as a mother of two young children, while co-owning a business and providing primary care to our community.
Along this journey, I also realized how disadvantaged female physicians are financially and emotionally. They are the ones taking the time to listen and care, with inadequate compensation, for the female patients also not valued and clearly understood in our society. The top leadership positions for negotiations for any major changes in our healthcare system were generally occupied by older white male government officials making the major decisions surrounding the outcomes of womens’ health and well-being.
The desperation and injustices witnessed South of the border ignited me further. At some point, female physicians needed to see change in our profession, moving towards a complete societal shift in how we are seen and viewed in the world. We formed an alliance during the pandemic; one of the most difficult and isolating times for women. This bright light materialized as “Our Fire Circle”, a small group that supported one another virtually through WhatsApp. We gave each other the strength to take on senior leadership positions through this mobilization. We braved the wilderness of rallying the government through grassroots organizations, various associations, our patients and patient advocacy groups. We ignored derogatory terms from some of our colleagues such as the “Ya- Ya Sisterhood” and comments like “I hope you have a wife at home if you are taking on this position”. By supporting each other mentally and emotionally, we negotiated one of the most gender equitable payment models for family physicians in BC to date, founded on caring for our patient’s needs and for their practitioners to thrive. Despite the fact that it was seen as an unintended positive consequence for gender equity, there was nothing unintended about it. We sacrificed months and months of meetings, planning, and missed morning drop-offs, our own health and wellbeing, and precious time away from our families.
For real tangible change to happen, we still had to operate within a patriarchal society which is detrimental to our mental and physical health. Even though our work had a tremendous impact and we are all celebrating it as we speak, this is not an environment where women leaders thrive and stay healthy. In fact, during this period, I ended up in hospital with severe back pain. This is where the real struggle lies, when you attempt to move the dial one step closer to gender equity, it comes at a cost mentally, physically, and spiritually. But why do we have to accept this? As our work demonstrates, we can challenge the societal rules on how to support women. Female leaders require the ability to feel connected, supported and empowered to have the ability to care for themselves. It’s not about equality as much as it’s about equity, understanding that if a social determinant of health is being female, we must acknowledge and adjust for our female leaders in the workplace and at home, so that they can care for themselves without all the societal expectations of being a caregiver for all. If we want to reach gender equity in every aspect of our lives including health care, this is a call to create environments that enable women to thrive, not just merely survive.
Sincerely,
Dr Zeineddin
Have you ever wondered if you think you are enough? Just the way you are? Regardless of how you are doing personally, physically, mentally, emotionally?
Usually we walk around wishing things were different, in some way, shape or form.
We start our lives learning how to survive and how to be enough in a family unit. My formative years of 0-5 happened during the Iranian revolution and then Iran/Iraq war. Now I never thought any of it affected me or the personality trait that I walk around with today. I learned how to cope and those coping mechanisms clearly served me.
I didn’t sit too long in any emotion as a child and moved on very quickly, getting things done, was a really good kid, low maintenance, and generally cared about others as a requirement to my worthiness.
This led me to an adulthood of becoming a healthcare provider, caring for others, which by the way I love doing as it brings me true joy. But, it’s the way I attach to that role that sometimes does not serve me. I kept always thinking and believing that in order to care for your loved ones or your patients or your family, you have to sacrifice from your own needs. That word sacrifice is extremely unhealthy because it means that you are ignoring your needs and not listening to your own mind/body/soul in order to fill the responsibility of being there for your family, friends or colleagues.
I had a patient the other day, tell me with her own words how tired and burnout she was at work, but wouldn’t consider taking a medical leave due to the effect it would have on her colleagues and team members. She told me “I feel like I have to sacrifice my own health and well-being in order to show that I’m a team player”. I had to ask her, what values do you prioritize the most? Being a team player or your health and well-being? Did you know you can’t be a team player if you are not well mentally and physically? She quickly understood that in order for her to feel worthy and enough she had to show that she was a team player, but you can still be worthy and enough being burnout and needing rest away from work.
This is something we always need to check in with ourselves. Why do we not give ourselves permission to take time off work, go on a medical leave, rest or do something for ourselves? It’s because sometimes our roles are too attached to our identity, impacting our health and well-being.
But I want to remind you as a Zili community, it is a journey we are all trying to figure out so it’s important to be kind and compassionate to ourselves, even when we recognize that sometimes the way we see our worthiness and the way we cope in life don’t serve our health and well-being. The first step is to acknowledge what you attach to your worthiness, and challenge that notion and keep telling yourself “I am enough” as the most important value you carry throughout this life.
Kind regards,
Dr. Z
“I am enough”
The three little words that changes your life
When I was a little girl, if someone told me to let go, I would feel unsafe and maybe even hurt. Why would anyone in their right mind tell me to let go? Let go of what? I am so little, I need to hold on to survive, I need my pillars of comfort.
​
As I grew older, the notion of letting go at that time was equal to being lazy and not working hard enough to get what you want. Letting go meant not being socially responsible and not caring for my duties as the older daughter of an immigrant family of three girls. It was so interesting how I had created this narrative that letting go was not something brave girls did. You never let go! Letting go meant not fighting for my rights and for all the things I believe in, like health equity, diversity and inclusion. Bravery was symbolized as “Never Letting Go”, a message strong woman may have been told over multiple generations.
​
As time went by, I grew up and faced hardships in motherhood, suffering from anxiety while trying to balance my professional life. Bravery for me was about getting through these tough years, but my mind was always in the future or the past. It was so hard to be present, even as life unfolded right in front of me and my children growing up.
​
My coping mechanisms sabotaged me as I was a hyper-achiever, a controller and a pleaser. I had a house, a loving husband, two beautiful girls, amazing friends, family and most of all, I was a business owner and family doctor, providing a service of continuity of care and primary care with my colleagues and staff for over 10,000 patients in our community. From the outside it was like seeing Pinterest pictures of the perfect kitchen or chef with no mess. But again, pictures don’t tell the whole story; pictures show moments. I was getting tired: tired of trying to balance it all, tired of not being fully present with my family and friends, and tired of working in a broken health care system with band-aid solutions with very little value for the work that goes into carrying for your patients. Trying to be a superwoman with no superpowers wears you down.
​
I began to feel brave once I felt vulnerable enough to admit how burnt out I was, and how little I was honoring myself. My coping mechanisms were no longer protecting me, like they did when I was younger. Instead, they were taking me away from myself, my essence and my loved ones. Showing myself any kindness or compassion during the pandemic felt indulgent, and therefore impossible. My roles and responsibilities were to hold space for patients with fears and worries, while being a mom of two daughters, a wife, a sister, a daughter, a friend, a negotiator for physicians, a CBC health contributor and the founder of a not-for-profit preventative health platform called Zili CARE.
​
I stepped back and took some time to rest. I began to gain insight and examined my perception of bravery and of letting go. For once in my life, I stopped ‘doing', noted my hyper-achiever, controller and pleaser saboteurs, and reflected on how I might set goals for myself differently. I redefined what strength and bravery meant to me.
​
Bravery for me is having the courage to acknowledge what’s sabotaging me, how I am feeling and finding a way to acknowledge it without judgment, i.e., letting go of expectations, letting go of some of my responsibilities that do not serve me, letting go of what I can’t control, to love myself intentionally and shift some of my perceptions and core beliefs that I am enough and worthy only because of my roles. Gabor Mate, a phenomenal mentor of mine told me, “Maryam, your worth is too attached to how much you care for others, and until the day you can understand to care for that part of you who is feeling so neglected, you will not find peace and calm”.
​
I still have many roles, and still try to have purpose and intention in my professional and personal life, but the difference now is that I don’t let my various roles take away time from the most important time of the day, me time! The entire purpose of our not-for-profit Zili CARE is to actualize an individualized plan for caring for oneself in order to achieve what fuels one's body, mind and soul. I am worthy regardless of my roles, and through mindfulness, self-compassion and self-awareness, I can acknowledge when my coping mechanisms get triggered. I note the trigger “guilt”, and then let it go. For me, just being and caring for myself is now an act of bravery.
Bravery in Letting Go
by Dr.Z
During these times of adversity, uncertainty, fear and anxiety over a virus that has already killed over 50,000 people, affecting over 700,000 individuals around the world, it’s safe to say we are at war with an invisible enemy.
​
When I was a little girl, I remember having to line up with my mom to get groceries with food rationing in place during the Iran/Iraq war. I remember my school closing down and not being able to see my friends for an extended period of time.
​
I remember our windows shattering due to the loud noise of the bombs in Tehran. Today, I watched my own daughter, at a similar age, cry when we drove to her empty school to pick up her school items and stare at the playground, she so adored, closed with yellow tape that surrounded the school. She saw her principle and vice principle directing us one by one into the school, with some wearing N95 masks, gloves and some with no masks. We later went to our local grocery store and you could feel the tension with everyone trying to keep their distance, keeping their mouth covered not showing a smile or any expression that I could figure out from their visible eyes. It was a sad morning.
​
SELF INQUIRY
I felt a rush of sadness and grief. I also felt anger, mixed with fear. I checked in with my body, and my arms/shoulder and neck were tense and in pain. Engaging in more of a ‘self-inquiry’, without judging the pain, I confirmed that my anxiety and fear was heightened, and that sadness was deep in my heart. I sat with the pain, took a breath and let my tears stream down my face. I knew that the perception I had from all this was pure grief at the loss of what I used to take for granted, the safety and comfort of my child going to school, the ease of grocery shopping and saying hello to my neighbours without worrying about getting sick or passing on a deadly virus. I know I took a lot of things for granted and I would have never thought life would be this different in such a short period of time. Some of us have the uncertainty of our financial situation, the worry of our loved ones getting sick and not being able to manage the uncertainty and the anxiety of this situation.
HOPE
My profession, all the health care providers, essential care workers and my country give me hope! My bravery give me hope to be there for my loved ones, my friends, family, colleagues and patients. Everyone deals with these times differently and we need to have compassion for our different ways of dealing with the many feelings and stages of grief. I have to recognize that when we feel certain emotions, they come with a set of memories attached to those feelings. When I felt sadness, fear and anger all at the same time, it brought me back to my childhood and war time. The amplification of my sadness and grief comes from my many other memories of grief that were probably not felt or dealt with and hidden in my subconscious for many years.
GRIEF AND ITS CORE BELIEF
Grief can mimic feelings other than the grief of loss of a loved one from death. It can remind you of losing a friend, a job, your home or your relationship. The perception of the emotion is the story we are attaching to the feeling. I feel sad because nothing is the same as before and I don’t know when things will ever go back to what they were, and if they don’t how are we going to manage and live under these circumstances? What if we can’t? Then we will examine the core belief underneath the layers of your perceptions and interpretations of your feelings. Generally, the core belief is that maybe we are not doing enough. Am I doing enough? Am I being good enough to my child, my patients, or my family? It always comes down to the core belief of not being good enough or worthy enough! That is when you need to question those beliefs and speak kindly to the part of you who is trying to protect you by bringing feelings of fear.
ATTEND TO THAT PART OF YOU
That part of you is probably quite young; the child who had to turn on your flight or fight response (your sympathetic nervous system) when there was a feeling of danger or lack of safety. Talk to that part of you, and make sure he/she feels safe and is attended to. Tell that part of you, thank you for protecting me, but I am okay, I feel safe and I will attend to your needs and make sure you are loved and cared for. This is something we generally don’t do during times of pandemic crisis. We are so worried about everyone else that there is that part of us that will get neglected so it will try to gain our attention by bringing feelings of fear and anxiety, maybe physical pains, lowered immunity, whatever it takes to gain your attention so that you can take care of yourself. If you want to reduce your fears so you can be of service to others, that part of you needs attention. That part of me, is the younger version of myself who remembers war times in Iran. It’s the part of me that never really spoke of my feelings of fear and anxiety and tried to always look brave in front of my parents so that they could attend to the needs of our community. I held all those emotions deep inside and now as an adult when those same emotions pop up, I know they come with memories from the past, and it’s the part of me that needs more attention. I don’t judge my feelings anymore, I don’t try to understand it more than what it is and try to sit and feel the pain for a few minutes and ask myself, what would make you feel safe and attended to?
Zili CARE FORMULA
Usually, it comes down to the Zili CARE Formula, where maybe my mind needs a bit of calming meditation (C-Calming your mind), or maybe a physical activity to put me in the zone of focus and flow (A-activate your body), or maybe my body needs nutrition, sleep or hydration (R-reinforce your body) and last but not least, it may be that my mental and physical health requires a social connection or an intention or meaning to do something for something bigger that myself, like my community (E-engage your soul) so that it can feed my soul.
​
At the end of the day, these times will pass. It will teach us self-awareness, self- compassion and the ability to feel our emotions without judgment so that we can be the best versions of ourselves for our loved ones and our community. We need you to feel whatever you are feeling, don’t judge it, let it pass, attend to the needs of the part of you who has brought anxiety to protect you, let that part of you know that you are going to be okay, you are safe and you are loved, and then go and attend to yourself with CARE so that you can attend to the needs of others.
​
Love and peace,
Maryam Zeineddin
A Personal Experience Of Fear And Grief
by Dr. Z
Most of us believe, or at least want to believe, that we are in a new era of increasing equality for women in the workplace. Yet at the same time, women’s mental health is suffering more than ever. Why are we struggling so hard to make it all work? It’s a question I’ve been asking myself and my patients constantly.
​
A Question of CEO Mentality
Working women generally have another full-time job outside of the workplace: they are the CEOs of their homes and families, and the caregivers for their parents. They may also volunteer in their kids’ schools, community centres, and community organizations, or sit on one or more boards of directors. This is all on top of their home and work responsibilities. To top it all off, working women have the added societal pressure of practicing the lifestyle measures of getting fit and slim, and trying to do everything possible to look younger than their age. Our society has somehow come to accept that women have unwittingly signed up to do all this; while a high-velocity stream of consumerism feeds us the products we think we need to reach these goals.
​
The questions: why do we buy into all this? What is the driving force that makes us need to be so many things to so many people? Is it purely guilt, or is it an innate caregiver/pleaser role that we are born into?
​
We endeavor to do our very best professionally, no matter what role we are in. To climb the ladder of leadership, we have to truly believe we deserve a promotion before we can even attempt to apply or request one – and we have a great deal of self-doubt. It’s a pressure-filled mentality: we must always be working at one hundred percent capacity to accomplish our tasks and goals to the best of our abilities.
​
Outside of work, we strive to be the greatest mothers, wives, friends, daughters, aunties and more. These roles are often prioritized over taking care of ourselves. It is very rare that we commit to taking the best care of ourselves before committing to the many other demands on our time.
​
Taking Best Care
Most of us are unable to recognize that we don’t even know what it means to “take the best care of ourselves.” It has just never been a priority; it’s something that comes after everything is completed at work and at home – which it rarely ever is. Even when we do have time to spend on ourselves, we fall back into “I should” statements, with goals of physical health (often with a focus on appearance), rather than mental health. This mindset is a major contributing factor to anxiety and depression. At the same time, there is still so much stigma attached to anxiety and depression, and many women do not wish to show signs of what they may perceive as “weakness” (which anxiety and depression are absolutely not).
​
Taking care of your mental health is at least as important as caring for your physical health, if not more. In fact, compromised mental health can translate into physical signs and symptoms including muscle ache, fatigue, and increased risk of heart disease, stroke, inflammatory illnesses and cancer.
​
The Insight to Let Go
The key to mental health is having insight into what your body and mind can handle each day. That means setting boundaries for yourself, and letting go of guilt. It means focusing on quality time rather than quantity of time with your loved ones. It requires letting go of your need to control everything, and allocating some of those responsibilities. But how do you get there?
​
Think about the way you try to exercise to improve your physical health. We need to take that same approach to exercising our minds to achieve a healthy mental state.
​
For example, even just 10 minutes a day of meditation with a guided app on your phone will start providing the calm you need to clear your mind to get in touch with your feelings; what you can handle; how to accept your thoughts without judgement. It’s a tool I use in my own life, and encourage my patients to explore. And it's one of many.
​
Calming the mind, Activating the Body, Reinforcing the Body and Energizing the Soul are the foundational components of Zili Care, and the focus of the Zili Conference 2019. We look forward to sharing intel, resources and tools from leading thinkers in the field in service of, and in the community of, women of all ages. I look forward to welcoming each and everyone of you.
​
Love and peace,
Maryam Zeineddin
Why are Women So Burnt Out?
by Dr.Z
About the Writer
Dr. Maryam Zeineddin
​Dr. Maryam Zeineddin earned her medical degree from the University of British Columbia in 2003 and St. Paul’s family practice residency in 2005. She is a co-owner and family physician at Ambleside Medical Centre in West Vancouver where she has a full practice with interest in all facets of family medicine, including preventative health and lifestyle counselling.
​
She is the founder of Zili CARE, a preventative health platform giving insights, tools and a sense of community for people to own their own health.
She is an avid teacher and clinical instructor for the UBC Family Practice Residency program.
​
She is actively involved in promoting universal health care with family physicians at the forefront of the Canadian healthcare system. She is a board member at the BC family Doctors and is a frequent CBC health columnist. As a full time working mother, Maryam realizes the importance of affording herself the same consideration and kindness she advocates for her patients. She studied an approach to therapy called Compassionate Inquiry mentored by Dr. Gabor Maté, to help soften the effects of repressed fear and pain, and practices mindfulness and meditation regularly herself.
​
Read her bio.