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Reimagining a Medical Career

There is a group of unsung medical professionals making significant contributions to Nova Scotia’s health-care system. Clinical assistants (CAs) – or clinical associates as they are known in other jurisdictions – like Dr. Himanthi De Silva work in tertiary and regional hospitals across the province.

These physicians are international medical graduates who have successfully completed Canadian medical exams required to allow them to work in Canada with a restricted medical licence. Most CAs have extensive postgraduate training and clinical experience.

Dr. De Silva felt the call to medicine in childhood. With a passion for science, she saw the great work of family members who were doctors and was mentored by them.

Becoming a doctor may have been her biggest dream, but the path wasn’t as she expected.

Born in Winnipeg, Dr. De Silva received her primary and secondary education in Sri Lanka, where her family moved after her father graduated with his PhD in structural engineering. She completed her medical degree in Pakistan at Liaquat University of Medical and Health Sciences.

“I practised as a general practitioner for nearly five years in Sri Lanka before relocating back to Canada with my husband, Dr. Ruwin Jayawarna, along with our daughter, Senali, and my mother, Moggali. Our son, Seneth, was later born in Canada,” said Dr. De Silva.

Returning to Canada, where her medical degree was not recognized by licensing bodies, meant that Dr. De Silva had to reimagine her skills and experience.

Dr. De Silva’s introduction to the Canadian health system was as a physician assistant in a family practice clinic in Calgary. She then worked for three years as a clinical associate in general internal medicine at Red Deer Regional Hospital.

“Living in Calgary and travelling the 150 kilometres to Red Deer was challenging but I loved my job, so I did it,” she recalled. “My mom was a great support to our family during that time.”

She worked in all areas of clinical practice, including inpatient and outpatient care, intensive care and emergency medicine.  “This enhanced my knowledge and clinical skills, and it furthered my understanding of the Canadian health-care system,” she said. “It also increased my interest in continuous professional development to incorporate the latest and best scientific practices when serving patients.”

For the past five years, Dr. De Silva has been a kidney transplant clinical assistant within the Division of Nephrology, Department of Medicine in Halifax.

Dr. Tammy Keough-Ryan is the Atlantic Canada kidney transplantation medical director for the Multi-Organ Transplant Program at Nova Scotia Health. “Himanthi is a wonderful addition to our team and it’s a joy to mentor her,” said Dr. Keough-Ryan. “Her professionalism, dedication, resilience and determination have made her a valuable member of the team.”

Dr. De Silva is grateful for the opportunity. “Dr. Keough-Ryan has been very supportive from the beginning and she is one of the reasons I love to work in the transplant environment,” she said.

With the upcoming changes to Nova Scotia’s Human Organ and Tissue Donation Act, transplant work is increasing in the province. Appreciating the value Dr. De Silva brings to the team, Dr. Keough-Ryan aims to hire another CA to support the division’s growing caseload.

The program provides long-term care for patients, including transplant evaluations, preoperative donor allocations, preoperative assessments, perioperative and postoperative transplant care, and outpatient life-long longitudinal follow-up care.

“The care is complex with multidimensional aspects of medical and surgical follow-up management required, encompassing urgent, emergent and chronic care decision-making,” said Dr. Keough-Ryan.

Dr. De Silva’s responsibilities include daily care of inpatients and rounds with transplant nephrology staff and the transplant team. She responds to acute medical emergencies, admissions and discharges. She works in the kidney transplant outpatient clinics three times a week and reviews outpatient clinic charts there daily.

The COVID-19 pandemic has been a challenging time for transplant patients because they are on immunosuppression medications and are at high risk of contracting the virus.

As services scaled down, staff in the renal transplant program had to triage care for patients, implement procedures to protect people from COVID-19 and find new ways to support patients.

“Transplant clinic follow-up care moved to telephone consultations,” Dr. De Silva said. “Face-to-face appointments are reserved for urgent cases, failing transplants or new transplants.”

Like all health professionals, clinical assistants have found the pandemic concerning, both personally and professionally. “I took all the necessary precautions at work and at home for the safety of my patients, as well as my family,” Dr. De Silva.

No matter the situation, what she enjoys most about her work is giving hope to patients with end-stage kidney disease.

“To be part of improving a patient’s quality of life, and the number of years they’ll live after kidney transplant, gives me great joy,” she said. “I’m humbled by the donors who give the gift of life and I value my role in helping make their generous gift matter. I love what I do.”