Standing in the bare-bones operating room in Hargeysa, Somaliland, Fahima Osman knew her patient, a 26-year-old man with a bowel obstruction, wouldn't make it without surgery. Back home in Canada, she'd have no doubt she could save him – as she did a few months later for an elderly Toronto woman who went home just three days later. But here, the hospital lacked a proper life-support system and optimal anesthetic. Even sutures were in short supply.
In the end, although the surgery itself went well, the young man died as soon as his breathing tube was removed. Looking down at him, Dr. Osman realized, "I don't have the heart for this."
Not an easy conclusion because, if anyone can claim to have heart, it's Fahima Osman. She first appeared in The Globe and Mail a decade ago as part of The New Canada, a series that explored the rise in interracial marriage, the shift in gay rights and the goals of young aboriginal Canadians in an attempt to see a changing nation from the perspective of the diverse, educated 20-somethings who define the next generation.
About to become the first Canadian-trained doctor in Toronto's Somali community, Dr. Osman was a remarkable example of an immigrant success story. A refugee to Canada at the age of 11, she had been raised by loving parents with no formal schooling in a large family where money was always tight.
In 2003, she was 25, a year away from graduating and planning to become a surgeon in Canada. But she also dreamed of volunteering back in Somaliland, the former British protectorate that had become part of Somalia only to break away after her parents had left.
"We are all brothers and sisters in the world," she said in 2003. "We all have a duty to help each other. It was just a matter of luck that we're born privileged and not a kid starving in Africa."
However, determination and a bright mind aren't always enough.
Dr. Osman had trained well – working as an emergency-room surgeon at Toronto's North York General hospital, as well as in rural communities in northern Ontario, believing the experience would help her most on the ground in Somaliland.
Yet she wasn't ready for the shortages in basic medical supplies and staff she would encounter. Other doctors did their best under the circumstances, but she felt helpless. Losing the young man in 2011 was her breaking point. "It was a case that opened my eyes," she says. "I was naïve before. You want to save the world. You live and you learn."
Rather than just give up, she returned to Canada to build her surgical career and find another way to help. She also fell in love, marrying Hosni Zaouali, a Tunisian who was completing his MBA in Quebec when they met at a fundraiser in Montreal. He is now the co-founder and director of Voila Learning, a nonprofit that tutors Canadians in French online, and uses the proceeds to support a virtual school for young Africans.
Last month, Dr. Osman completed a fellowship in breast cancer surgery at the University of Toronto, and is currently in Paris, on her own initiative, to study oncoplastic surgery, a cutting-edge technique that improves the cosmetic appearance of the breast after the tumour is removed.
Two years ago, still thinking of Somaliland, she started work on a master's degree in public health at Johns Hopkins University in Baltimore, to learn more about developing the health care system in low-income countries. "I need to help myself before I help anyone else," she says.
Dr. Osman realized that what Somaliland needs aren't more Canadian-trained doctors doing their best to patch holes, but locally trained surgeons and specialists to build a better system, one that truly understands the country's culture and circumstances. So she now plans to create a foundation to work toward that goal by providing money and mentors. She has already begun to build links with more advanced medical schools in neighbouring Ethiopia, since there are no surgical-residency programs in Somaliland.
After all, Dr. Osman understands better than most the value of mentors and support networks, particularly when you are a trailblazer in your community.
"Everybody loves an underdog," she says, "and my story was that."
Growing up, she had no professional role models and no outside incentives to succeed, other than her family's belief in her abilities and the decorative A-plus letters she hung all around her bedroom. Even a high-school guidance counsellor once chided her for aiming too high.
In university, she jokes, she became a "doctor groupie," badgering friends with relatives in the medical profession, doggedly pursuing anyone willing to offer advice over coffee.
She focused on her own goals for so long, she says, that it was only last year, sitting in a class on social capital at Johns Hopkins, that she truly realized how she had beaten the odds just to be in that lecture hall. Her more well-off peers had built-in stepping stones, thanks to their parents and the opportunities that circumstance afforded them.
Poor kids, even the best students, have to be "exceptional" to succeed – just like a country struggling to build a medical system virtually from scratch. "They have to work 10 times harder to become successful," Dr. Osman says.
And so Fahima Osman, older, wiser and no longer defined by her underdog status, has one piece of advice for Canada: Look out for young people like her, who have big goals and bright talents but may need a helping hand.
That means preserving social programs in disadvantaged neighbourhoods, she says, and having successful professionals reach out to students to guide their choices. If the country needs inspiration, it can find her in surgery, still trying to saving the world, one way or another.