A life in public health

Bewley B and Bewley S. My life as a woman and doctor. Bristol: Silverwood, 2016. ISBN 9781781324196

Dame Beulah Bewley was born Beulah Knox in Northern Ireland in 1929. Most of her childhood and youth were spent in Eire, where she then studied medicine at Trinity College Dublin, graduating in 1953. Beulah then followed a remarkably varied medical career in England and the USA, in both hospital and community settings. It was while recovering from spinal surgery in 1969 that she decided to try a new MSc course at the London School of Hygiene & Tropical Medicine. This was a turning point in her trajectory to Public Health. By the 1980s when she was teaching at St. George’s Hospital, she was already known for her ground-breaking work on the impact of smoking in childhood. Today, across health professionals, there is a consensus that smoking is a major cause of preventable illness and death, but pioneers of smoking research found it extremely difficult to overcome both entrenched medical opinion and vested commercial interests. ¹ At a time when health researchers were encouraged to become narrow ‘experts’ in one specialist field, ² Beulah’s curiosity and collaborations were wide-ranging. ³ She was also postgraduate academic tutor for the South West Thames Region, a role she undertook with dedication.

Beulah’s external roles included President of the RSM Section of Epidemiology & Public Health and the Medical Women’s Federation, and these interests overlapped in the 1990s as she campaigned about inequalities in the medical profession, ‘where women have still not achieved their full potential’. ⁴ If only the present Secretary of State for Health had learned from Beulah’s wide-ranging observation of women who are medical trainees! ⁵

When Beulah graduated from Trinity College Dublin, medical careers were very different.

I remember the importance of nepotism and the need to have a sponsor. It was quite important in those days to have a relative in the medical field; for example I got my first job in the UK thanks to my uncle in Ipswich. ³

When later she was President of the Medical Women’s Federation, and regularly invited to dine with the heads of various professional bodies and Royal Colleges, she was fearless in advocating for more women on everybody’s Council. Armed in advance with figures on their representation of women, she would pressure every President with ‘Why are your figures so bad?’ ³ She stressed the need for more female, Consultant, role models, and to the women she trained (e.g. Corinne Camilleri-Ferrante FFPH⁶) she imparted determination and courage. After initial work in Paediatrics and Family Planning and having five children, Beulah began her training in Community Medicine at the London School of Hygiene & Tropical Medicine in 1969, before the organisation of public health ⁷ was radically ‘reformed’ under Barbara Castle. As a trainee, her first project was overseen by Walter Holland, who later supervised her MD research at Trinity College Dublin. The multiple effects of smoking on health were not so well understood in those days, and Beulah’s determination took her research into controversial areas, such as the risks during pregnancy. ⁸ Long before there was such a speciality as Adolescent Medicine, ⁹ she identified an urgent need for improved health statistics (including data linkage with education, youth unemployment, crime and accident data) to improve teenage health. ¹⁰

In her public health role, Beulah took great pleasure in other people’s achievements. When another Trinity College Dublin alumnus (Tim Moore FFPH) was probed for his memories of Beulah, her enthusiastic encouragement was the first thing he recalled. Generosity was a characteristic many doctors associated with Beulah. Today’s Trainees should note: this was rooted in something much deeper than medicine. It sprang from the unflagging love of her family, first in Ireland and then following her marriage to Thomas Bewley. Her world view was anchored in her faith in God.

Thomas became President of the Royal College of Psychiatrists, and unusually for a specialist in Public Health, Beulah’s experience included jobs at several mental hospitals. Susan, Louisa, Henry and Emma Bewley all grew up in a house in the grounds of Tooting Bec mental hospital. Sarah, who was premature and disabled, grew up in permanent medical care. In her 80s, Beulah has become increasingly debilitated, and it was the patient, loving work of her surviving children to compile her life story ³ from three years of painstaking, individual ‘interviews’ with their mother.

And what a varied life that has been. Many epidemiologists pay lip-service to the Social Determinants of Health, but Beulah took on an active role as the medical member of the Central Council for Education and Training in Social Work. ¹¹ When she reflected on the most valuable work she had done for patients, it was her time in Family Planning. When she was made a Dame of the British Empire at the Millennium, it was for her service to women in medicine. From childhood, she made new friends through her love of music, and it is said that she combined music and medicine when she went to the aid of a famous Tenor who collapsed at the Opera House … .

Remembering her dedication as postgraduate tutor, she would probably want this essay to end with a life lesson for today’s Junior Doctors:

‘I do, and don’t, regret the way my career took twists and turns’. ³