Picture of Kirsten PatrickKirsten Patrick is Deputy Editor at CMAJ. She is currently attending the Canadian Paediatric Society annual meeting in Charlottetown, PEI


For the past two-and-a-bit days I’ve been privileged to be able to attend the Canadian Paediatric Society annual meeting. I love this community of physicians. They come across as the most optimistic, caring and forward-thinking group. Participants always come with families and even small babies in tow. They seem to be, without exception, interested in improving the wellbeing of every child not just some kids. I always leave the conference feeling uplifted by what I have heard and learned, and hopeful about the strategies being developed by the CPS.

This morning I woke up to discover that #Brexit was no longer something abstract that I was pretty sure couldn’t possibly happen, but something real that a 52% majority of people in a country of which I am a citizen decided was something they’d like to try. My social media feeds were full of peoples’ shock and disbelief; clearly my friends and acquaintances voted as I did – to remain part of the European Union – convinced by the many evidence-based and thoughtful arguments about why EU membership is good for the UK in so many ways.

One friend, an occupational therapist, wrote, “I feel like someone else has voted for us all not to have friends,” and I thought, yes, that’s what I’m struggling to understand… “Why are people voting for separateness when we all know the value of harmonious community?” I should make it clear that I’m an ÜberIntrovert. I like separateness so much that it’s tough for my life partner to deal with. But I’m also capable of logical and reflective thought; I know that there’s a lot of evidence to show that this tendency can harm me so I do what I can to maintain relationships to bolster my mental health. Similarly, I have become – through a process of education I’ll admit – more politically bent towards inclusiveness, voting on the basis of sound evidence where possible and aiming to support policies that will make a better world for everyone not just for me and my family and other people like us.

I was born and raised in South Africa in the 70s and 80s when Apartheid was just the ‘way things were’, and inequality meant nothing to me in my white, segregated childhood world, bubble-wrapped by heavily censored media. The year after I left high school was the first year that kids of all races were allowed to go to school together in my country. Needless to say, going to University, and especially to medical school, which involved training in Johannesburg’s public hospitals, completely rewired my brain. My first experience of voting was when I was 19, in a referendum in 1992 – ‘Should nonwhites be allowed to vote in a general election? Yes or No’. By then I had Black, Indian and Coloured (I won’t explain why it is okay to use this descriptor in South Africa; it just is) med school friends; it was a no-brainer. And happily sense prevailed. My next voting outing was for the legendary 1994 election that brought Nelson Mandela to power. After my internship I spent a year doing community service in a rural hospital in KwaZulu-Natal, South Africa – I saw in the new millennium in an operating theatre doing an emergency C-section. There I learned what real poverty looks like – the kind of poverty that has kids presenting with vitamin deficiencies that haven’t been seen in the developed world for decades. And then I went to work in the UK at the height of the New Labour government and I began to understand what policy aimed at raising the standard for those at the bottom of society looked like. I worked as a mother-and-infant mental health researcher at the Institute of Psychiatry in South London and  I saw the struggles of disadvantaged families – and what a little bit of helpful social policy could achieve. I had my own kids and I benefited from social and economic policy that aimed to make it easier for me to raise my kids. And I knew I would never ever think only of myself when I voted again.

The reason that I voted to Remain in the EU is because many of the progressive policies and programs that are in place in the UK have been shaped by EU policy or funded by the EU. Contrary to the rhetoric of the Leave campaigners, the UK government does not receive EU directives as diktats; UK parliament votes on and implements its own laws and policies, some of which are underpinned by an EU directive (which is a legislative act that expresses a goal that all European Members must achieve). So, as many have pointed out, we have the EU to thank for things that are great for us, like laws around the number of hours people should work without a break or the amount of maternity leave and pay women or parents get.

Last week Dr Ben Goldacre (“Bad Science”) said, in a post on his Facebook page, “A smaller democracy will not be more representative. The UK government is no more under your control than the EU. Diluting your vote one in 65m or one in 500m amounts to the same thing: no control. You couldn’t get political agreement from the people in one family, one pub, or one bus. You can’t “vote them out”, you’ve never done that, stop pretending you can do it in the future. Politics is about compromise: terrible, soul-destroying, mature compromise with other people, most of whom are awful. Your local council doesn’t represent your views and values any better than your MEP.”

That comes across as a bit depressing; it’s very British to be hugely doom-and-gloom and expect that to be uplifting….I know that he was trying to debunk myths peddled by the Leave camp at the time. I might have put it slightly differently. Something like this, perhaps…

Choosing to vote or act politically in a wider community rather than a smaller one may seem like a recipe for having less control. But don’t underestimate the power of your potential influence. You, as an individual, have influence, so you may as well have it in a bigger arena. Politics is about compromise: mature compromise with other people, many of whom don’t share your views. It takes effort and skill to engage with others and find common ground, but this is THE ONLY WAY to achieve anything worth achieving. Walking away achieves nothing.

It’s like intimate relationships. Making them work well is a slog. It takes communication, more communication, active listening, a willingness to imagine yourself in the other person’s shoes, respect for the experience and feelings of the other party, and yet more communication….and more of the same tomorrow…and the next day.

Another Facebook friend reacted to the EU referendum result with sadness… “I wanted my son to grow up as part of something bigger than little England, something culturally diverse and tolerant, where he could enjoy the best aspects of European culture from all the countries.” I think her son will do just that. Because he will grow up under the wing of her parenting and she respects diversity and tolerance and will take care to teach him to appreciate the best of what other cultures have to offer.

I also despair over the ‘state of the world’ and worry about what my children will inherit. But over the last three days, many paediatricians at the CPS meeting have helped me to remember to have hope. It is humbling to meet people who have dedicated their lives to the service of others and fight to speak for those who have no voice. It is uplifting to meet professionals who have learned in the course of their careers to listen to communities, to find out about what they need rather than telling them what they need. These docs have shored up my faith in the growing power, in a globalizing world, of local community, civil society and professional groups. They’ve restored my faith in the power of my vote to work together for a better world that can work for everyone.