Doctor stories
September 5, 2022
Dr Carmen Basu on changing the system

Dr Carmen Basu is the founder of Milk and Honey Paediatrics, Carmen is a paediatrician and disillusioned with her ability to innovate in the public health system has pioneered a new way of approaching life in the first 1000 days. This is a fascinating approach, and If you think about how important those first 1000 days are, it's significant work. 

She's passionate about addressing inequalities in our health system and is taking massive action to address some of those inequalities in the ways that she can. 

Dr Sam Hazledine caught up with her on his Better Together podcast to find out about her new venture and discuss the flaws in our current system that inspired her new way of thinking. 

Listen to the podcast:

Early life:

Dr Carmen Basu knew that she wanted to be a doctor when she visited New York and she passed the medical school in Manhattan. “There are these Hogwarts-looking doors with this really ancient Latin inscription above it. And it caught my eye because it had the word ‘disco’ on it. And I didn't think that ‘disco’ was a Latin term. So out of curiosity, I went and looked it up. And that fancy Latin inscription above the medical school doors, reads, roughly translated something like “no stranger to troubles myself, I'm learning to help others in distress.”” 

It was reading these words that inspired Carmen’s journey into medicine. “The idea of the wounded healer… I think you probably have come across lots of doctors whose journey into medicine has been because they've experienced illness or been exposed to illness themselves. And you walk the path of medicine trying to make sense of what happened to you. And so that was very much me.” 

Carmen was an only child of immigrant parents, “both of my parents were extremely unwell when I was a child and entered into the medical system many times, and were often misdiagnosed.”  When she was nine, her father died, and then her mother nearly followed. “I think that exposure to all the doctors and nurses at that time, seeing how much power they held, and their ability to really shape-shift your life based on their connection with you and your family, and what they observed. That really stayed with me.” 

Milk and Honey Paediatrics 

Based in Auckland, Milk and Honey Paediatrics creates deeply supportive and nourishing experiences for Māmā, Pēpī and Whānau through those significant first 1000 days of life and beyond.

“The idea was really born out of a massive amount of disillusionment with the medical system. And then in myself, I'd come to a standstill, a forced standstill, and point of reflection because I ended up having a surprise baby,” explained Carmen. 

This was when she met Dr Abby Baskett (Co-Founder of Milk and Honey) “And I remember sitting with her, when my baby was four months old and breastfeeding it, and both of us downloading our 10-years worth of frustration at working within the medical system. And what we would change about it.” 

This was when Milk and Honey was born, Abby and Carmen decided that they wanted to focus on the first 1000 days of life. 

“The first 1000 days is a concept that's been around now for about 10 years, led by really amazing doctors like Nadine Burke Harris, who have identified that if there is any trauma or any major life events that occurred to you in the first 1000 days of life, and now possibly even in your antenatal period, that has a huge impact on your health…it also reverberates decades later. And yet, funding structures, and health care funding structures in education in this country are funding structures in the policies around parental leave, and things like that do not support the first 1000 days very well.” 

With too many obstacles to overcome within the public health system, Carmen and Abby decided to set up a private practice. 

“You can't innovate in a huge gigantic structure that has, you know, decades of bureaucracy and politics behind it, what you need is a fresh start to release the creativity.” 

They didn’t have government funding but they wanted to make it very clear from the beginning that their doors were open to the communities that are normally considered marginalised, particularly in the healthcare setting, or who are normally not well served by big health institutions. 

The pair enlisted a company called Engaging Well. “They talked to us about embedding Māori principles right from the get-go, and creating a culture and a space that welcomed those that don't normally feel welcome in a hospital. And then creating not just the concepts within our healthcare, but then looking at how we can redistribute the equity that we have.” 

Without government funding, Milk and Honey has to think differently: “we redistribute some of the profits that we make into what we call our “honeypot.” So, we have a separate account, which is our social initiative. And some of our profit goes into that. So if you come and visit us and your private insurance company pays for your appointment, we'll put some of that money into the honeypot. We will also, later on, be holding bigger fundraisers and hoping to go into partnership with businesses and bigger institutions that can donate to the honeypot.” 

This creates a system of equality  “If you come into our clinic, nobody knows. Did you pay for your appointment? Did your insurance company pay for your appointment, or did the honeypot pay for your appointment?” 

Carmen hopes that the model she and Abby have created could, not only inspire other practices, but also the system.  “If we can create a workforce that looks different from the traditional ideology, you know, the traditional views that we have of medicine, which tends to be sort of a panel of old white men. If we could change that up a little bit and say, “look, you can enter our clinic and the person at the desk might be from a completely different culture, a completely different background to what you're used to, but they can do this job too”  then that helps show people a little microcosm of what the medical world could be. And it's just a little experiment to show people that it can be different.” 

The problem with the system 

Carmen explains that the problem with the system is that “the structures within your departments, your clinics, your operating rooms are driven by your management structures and the funding that goes into those, and if you don't have good representation, in those structures, they will just serve the people that look like the people who are in management.”

In order to succeed in these institutions “you have to be a certain way, talk a certain way, be a sort of cookie-cutter model, a model of what a consultant should look like, or what a hospital manager should look like.” This is what’s feeding inequities.

Carmen says the problem is that a big shift is needed, but instead the industry is only making small changes.  “You're only still helping the same types of people again, and again, because you’re doing the same things again and again. So I think that the thing that's driving inequities is that we're not doing these big cultural shifts and shape-shifting the model completely. We're just making small changes.” 

Carmen provides an example, “a lot of these changes seem very tokenistic when you're from marginalised groups, you know, things like a rainbow tick, for example, or having your values for your DHB written out in Te Reo Māori. That's not what those communities are asking for. They're not asking you to learn Māori, they're not asking for the rainbow tick.” 

Why the first 1000 days? 

Countries, like Sweden, whose governments are supporting the first 1000 days are seeing results: “we always talk about the Shangri La of Scandinavia in paediatric. When you look at countries like Sweden and Norway, and you look at what the government funds for children, they put all their funding in the first 1000 days.” 

“And when you look at their outcomes, they have higher literacy rates, lower mental health problems in children, and more people entering tertiary education. And we know that there is a link between the higher educated you are the better, the healthier you are” 

She hopes that through Milk and Honey’s model she can inspire the government to make changes. An ideal outcome for Carmen would look something like this:  “If a hospital District Health Board turned around and saw our clinic and said, “yeah, we will fund that. We will will redistribute funds to make sure that we contribute towards that.”  Any part of the government could look at it and say, “yes, there is value in this. There is value in the first 1000 days, of course, in health, we should be focusing on the first 1000 days. Oh, my goodness, did we roadblock this for 10 years? We are so sorry. Here's the funding, and let's model this throughout all the regions in New Zealand.” We would love that.” 

To conclude Sam asks, “if you could go back in time and speak to your 18-year-old self, just getting into med school, what would you say are the three most important things that you would advise her to you know, to have a great life or you know, have a great life? 

"I know that this is not that this is helpful for the podcast, but I'd be so tempted to go back and just say don't do all those bad haircuts and have all those bad boyfriends. But that is not the answer you're looking for…I would say things like:"

1. "Both in medicine and in life. Things don't always go according to plan. And that's okay, If it doesn't go according to plan, you can't control everything. Sometimes the hardest thing in medicine and in life is to do nothing and just let time pass."

2. Probably one of the other things I would be saying to myself is, do things to make yourself happy and stick to your own values. Don't don't do things to please other people and seek approval from other people.

3. "Remember the reason you entered medicine was to serve patients and families. And it isn't to please or impress your colleagues or management. Stay true to that and stay strong on that path because it is a bumpy road. But ultimately, that's the road where you have some integrity to the profession."

How would you want to be remembered?

“Despite my ardent feminist leanings, I think I probably mostly want to be remembered in life as a warm nurturing loving mother to my two sons, and maybe the world's best stepmother and aunt too, but I'm in medicine, and I guess I would just like to be an inspiration for those who don't see themselves reflected well in medicine. That for somebody who comes from an unconventional background, I just want to be a little light for them, and to say: "you can you can do it" and "we need people like you to be the force for change" because you know, I'm part of the old guard really, and I just really want to be there to help raise up those those people that could be the new innovators because they have a different perspective.

Article by
Dr Carmen Basu

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