The doctor is in

Globe and Mail

24-05-2025

When Fahima Osman mentors aspiring medical students in Canada's Somali community, her advice is the same: Get to know yourself until you find the gift you were meant to give to the world. 'Then chase it,' she tells them, 'but be smart about it.'
Twenty years ago, this was all Dr. Osman possessed: her own smarts, energized by childhood ambitions and supportive parents.
Like many households in Toronto's Somali community, the largest African diaspora in the country, her family was poor, still getting their footing in Canada. The eldest of six, Dr. Osman crammed for tests between part-time jobs to help with rent and groceries.
In 2003, when The Globe and Mail went looking for the first Somali refugee to become a doctor in Canada, we found a fiercely determined 25-year-old, one year from graduating medical school at the University of Toronto.
At the time, despite the diversity of her class, Dr. Osman was the only African student, and she knew many hopes were riding on her success.
To force herself to study late into the night, she'd taken to parking in the most expensive lot on campus; if she lasted to midnight, the attendant would leave and she wouldn't have to drain her tight budget to pay.
Fast-forward two decades: today, Dr. Osman, 47, is a respected breast-cancer surgeon and an entrepreneur trying to improve the country's health care system.
This summer, she will take a new surgical oncology position at Women's College Hospital and will start an academic position as a surgeon investigator in entrepreneurship and innovation at the University of Toronto.
There's no thought of slowing down. 'My patients need me,' she says.
And yet, having defied expectations and achieved her dream, she's now asking herself: 'What do I want to leave behind?'
Resting on her laurels is not how she was raised. Her family arrived in Toronto, when she was 11, with a few bags and her parents' framed wedding picture. In high school, Dr. Osman taped letter As to her bedroom wall and ignored the guidance counsellor who told her not to aim so high.
When she was despondent about studying hard for a less-then-perfect mark, her mother would detail a real-life tragedy to remind her to be grateful. Her younger siblings teased her about pulling all-nighters studying just to 'get into' high school, but indulged the medical documentaries she always wanted to watch.
From her father, she learned resilience. Adam Osman grew up in a desert, nearly drowned on an overcrowded fishing boat to escape poverty and used his wits and connections to get his family safely to Canada, with civil war breaking out in Somalia.
He died of cancer, under his daughter's care, at home in 2018. In one of their last conversations, Dr. Osman sought his advice about her next career steps.
By then, she had a successful surgical practice, and a happy life with her husband and young son. (Her daughter was born the following year.)
Maybe this was enough. Should she take on more stress to push for change? 'Be strong,' her dad told her, in Somali, 'and go for it.'
She held those words close, because her father had always been wise counsel, and because she is still haunted by the patients she couldn't help. Earlier in her career, she planned to work regular stints in Somali, to give back to her birth country. But then she lost a young patient after a successful surgery only because the hospital didn't have the proper resources, and she realized that sense of helplessness would eventually break her spirit.
She returned home, and has spent the past 11 years, at North York General Hospital, operating on breast-cancer patients and performing general surgeries.
But even in Toronto's high-tech, well-stocked hospital, she saw gaps in care. Day to day, patients, receiving the worst news of their lives, would tell her that a one-hour consultation was not enough time to understand the disease and make an informed decision. This massive 'brain dump,' as Dr. Osman calls it, increased the risk of misinformation.
She once spent three appointments talking to a woman with a good prognosis out of remortgaging her house for an experimental treatment in New York. Another patient wanted to try expensive vitamin C and mistletoe injections. Dr. Fahima persuaded her to get them, while still receiving the evidence-based standard of care.
But her most heart-breaking example was a 30-something mother with a treatable cancer who was persuaded by her husband not to get surgery. Dr. Osman called her so many times to reconsider that the woman finally delivered flowers to reception. The included card thanked Dr. Osman for being a caring doctor, but asked to her to leave it be. Racing to catch the patient in the hall, Dr. Osman said she would respect the woman's decision. 'But please,' she told her, 'my door is always open wide for you.'
Two years later, the women returned. Her cancer had spread to the liver and lungs and was now terminal. Dr. Osman was on maternity leave, but she heard her former patient had asked a colleague, 'Is Dr. Osman going to be mad at me?' At home with a new baby, Dr. Osman wept for the children who would now have to grow up without their mother.
Delivering more compassionate and informed care, Dr. Osman says, requires more co-ordinated, well-timed information for both the patient and the health care team. As one solution, she worked with a team of engineers to design a data-rich platform called My Journey.
The platform, which was used at North York from 2022 until Dr. Osman left in the spring, gives patients individualized information at each stage of treatment, allows staff to book appointments, and collects test results for doctors to discuss treatment plans. Last year, for her work on My Journey, Dr. Osman received Ontario's Life Sciences Innovator of the Year.
Easy access to all this information is important for patients and doctors, and essential for hospitals, she says. And yet her Peloton gives more progress data on her workouts than she often has for her surgeries. Sometimes, she only learns the negative outcome of a patient when they are admitted to palliative care.
'How can you improve without data?' she asks. And how can patients truly understand their options without the best information? 'I want to make my patients mini-oncologists,' she says. 'If I had to leave an ode to my career, it would be to make navigating cancer easier.'
In her new academic post, Dr. Osman hopes to support more home-grown innovations within health care. 'It is a very challenging field to be an entrepreneur,' she says. Funding is hard to find, surgeons aren't business experts, and health care systems are slow to change.
'But we need Canadian solutions more than ever,' she says, pointing to the current trade war. 'Who better to innovate than the doctors and nurses - and also patients - who work and live in the system, day in and day out?'
Dr. Osman still sees her younger self in the students she mentors − the spark when they talk about medicine, the weariness of working hard to achieve for their families. She gives them the advice she could have used, forging ahead on her own decades ago − how to find advisers, what courses to take.
When they come to her feeling defeated, she reminds them of the teacher who once told her she wouldn't make it.
And she still takes lessons from her 25-year-old self, who felt like an outsider at her dream job, adrift in a complicated medical environment.
'Seeing where I came from and what I've become, gives me hope that I can do anything.'
She has her mission for the next stage of her career: to empower her patients in their care and simplify their journey through it. To inspire the next generation of Canadian surgeon entrepreneurs. And, as she says, 'to enjoy her pillow,' with no regrets, when she finally falls asleep each night.
The envelope arrived on a Tuesday, a sunny and hot June 4, 2000, just before 1 p.m.
All the Osmans remember it: The day before, Fahima and her mother had gone to the end of their street in Markham, Ont., to the brown super-mailboxes, shoving the key into 10A slot with their hearts pounding, only to find it empty. They knew the mailman delivered just after noon. They knew McMaster University had sent their answer off on Friday. Fahima hadn't slept all night; she had borrowed a cellphone to call the long list of family waiting to hear. On Tuesday, her mom, Zahra, who considers herself 'a lucky woman,' insisted on being the one to open the mailbox and reach inside. It was a package so deliciously fat and bulging, they didn't even have to open it. There was no mistaking what it said. Screaming, Fahima tackled her mother in a hug and kissed her. Zahra started crying. Her daughter was going to medical school.
'I used to wonder how people cried with joy,' Fahima, now 25, recalls. 'That day I found out.'
The next big date is May 14, 2004, when Fahima Osman will have earned the right to put two long-dreamed-of letters before her name. And in that moment, the Somali refugee – whose parents had no formal schooling, whose father nearly drowned trying to flee a life of poverty, and whose high-school guidance counsellor once warned her not to aim so high – will become an original: the first Canadian-trained medical doctor in the country's largest African community.
To reckon with how far Fahima has come, you have to look back more than 50 years, to an enterprising 10-year-old named Adam Osman, born to a long line of nomads in the desert. He spent his early years wandering in the dust with the sheep and camels, trading for water or food and living under makeshift canopies of branches and cloth. Years later, when his children refused to finish their suppers, he would tell them about getting rationed his one cup of milk every second day.
Adam's mother died when he was little, and his father remarried. As the second-oldest boy among 12 children, he was sent to make his way in the northern city of Hargeysa, working for a local merchant and farmer. At 15, he learned to drive a taxi and he saved enough money to bring two brothers into the city, and send the youngest to school.
But he had ambition and he was clever, and with a bit more money, he managed to buy a one-way ticket to Yemen, where he paid 500 Yemen shillings – a fortune – to join 100 other stowaways on an unstable fishing boat bound for the United Arab Emirates. Finally, approaching land after days of motoring, the boat began to sink. Adam Osman could not swim. But while people churned helplessly in the water around him, he was pulled to safety by one of the other passengers and dropped on the beach.
His luck held in Abu Dhabi: He landed a job with a Canadian oil company, and worked himself up to a public-relations position that saw him organizing visas and ferrying around staff members. He paid for more siblings to go to school.
At 38, well past the age Somali men typically marry, he decided he was settled enough and sent home to his brothers and father to look for a wife. The name they produced was Zahra Ali, the 17-year-old daughter of the now-deceased merchant who had given him his first break.
Zahra was nervous about marrying someone so old, but she knew the way of these things. 'I didn't have a choice,' she says now. 'I respected my family.' She was married in white in Abu Dhabi. Two years later, in April, 1978, their first daughter, Fahima, was born.
By the late 1980s, the Canadian oil company had come up dry. Adam was given six months' notice, and with no job, he was not allowed to stay in the UAE. But the couple could not go home. They had six young children, and the political situation in Somalia was deteriorating, heading toward civil war. Zahra's family fell on the wrong side: 'If we had gone back, they would have killed me,' she explains, wiping a finger across her throat.
Her husband, who knew his way around bureaucracy, got them all visas to the United States, and they spent everything they had to fly to New York City. They went to Buffalo and crossed over to Canadian soil in July, 1989, carrying nothing but a few bags and a framed wedding picture, and declared themselves refugees. The children spoke some English, with heavy accents, but their mother none at all. On the ride to Toronto, she watched the taxi driver speak into his radio and worried they were being kidnapped. In the back seat was Fahima, springy curls down past her shoulders, at 11.
Their story was by no means the worst. In those years, a flood of Somali refugees – including many single mothers – came directly to Canada, arriving poor and traumatized by violence and famine. Most settled in Toronto, where they are now believed to form the largest African community in Canada.
How large is unclear. The 2001 census records less than 20,000 Torontonians who named Somali as their ethnic origin, but Farah Khayre, co-ordinator at the African Canadian Social Development Council, estimates the number at closer to 60,000. People move often, she says, and may list themselves as African or be nervous about sharing personal information. The community is very young (almost half below the age of 15) and very poor, with an average income per adult of about $15,000, less than half the average for Toronto as a whole.
Somalis in Toronto have struggled to find affordable housing for their large families, Ms. Khayre says, and the parents, who see a growing generational gap, worry about keeping their children in school and out of gangs.
But in the past decade, they have formed outreach organizations and women's centres. The first Somali restaurant has been followed by about 30 more. They have begun to produce university graduates: While the three eldest Osman offspring remember being virtually alone in their first years at York University, they now see a crowd of Somali-Canadian freshmen.
In all that time, though, the community has yet to produce a doctor. There are at least two dentists, and an older, U.S.-trained psychiatrist in nearby Whitby, but Somali Torontonians have survived without a single family physician who could speak to them in their own language and relate to their largely Muslim culture. None of the Somali doctors who arrived as refugees have been able to get their foreign credentials recognized. Often, they work as counsellors or taxi drivers.
To Deqa Farah, a community mental-health consultant, Fahima's achievement is both a symbolic triumph for her young community and a practical necessity: No matter what she does after medical school, others will have an example to follow. 'It means we are here,' Ms. Farah says. 'We are no longer a refugee community. We are citizens.'
In the Osman home in Markham, Fahima's family is fast consuming a table loaded with baked chicken, rice and homemade samosas. There are at least four conversations under way.
Her youngest sister, Shukri, who turned 6 the day before, is proudly toting her new Barbies in a shopping bag. Her brothers, Mohamed and Hamza, have set up around a plastic table in the back yard with two cousins – their father, a banker in the UAE, was the first brother Adam Osman put through school.
Fahima's mother straightens her hijab with an easy smile, and goes hunting for forks. Except during Ramadan, when they try to break the fast together, it is rare that her nine children are all under the same roof.
Though money is always tight, it is a given in the family that everyone will go to university – not college, their father tells them sternly, but a 'brand name' education.
On that subject, Fahima's parents, who can read and write only a little English, are of one mind. Zahra has been the sole breadwinner since Adam fell ill and retired from his valet job; she keeps the house and works nights making humidifiers on the Emerson factory assembly line. Flanked warmly by her daughters in the kitchen, she describes what she wishes for her children: 'Just work hard and have a good life.'
Hodan, the second oldest, laughs. 'Notice the emphasis on hard work. There is no room for laziness.'
The children have complied: Hodan, 23, graduates this year from York University and plans to get her MBA. Hibo, 22, is taking statistics. Mohamed, the eldest boy, is in computer science at Ryerson University. Huwaida, 18, starts next year at York; she wants to be a teacher.
And then there is Fahima, who came first and set the family bar. Her siblings, who gave her nicknames like Party Crasher and Mood Killer, tease her mercilessly about how she pulled all-nighters studying just to 'get into' high school, how she decorated her room in A-pluses for motivation, how she made them watch medical documentaries and World Vision programs.
The conversation goes something like this:
'We'd watch them for hours,' Hibo says. 'The worst ones were the leprosy shows. I still can't get those out of mind.'
'It was to remind us to be more grateful for what we had,' Fahima protests.
'She once made me watch an episode of Law and Order and write a report on it,' sister Deqa, 13, says.
'To practise writing,' Fahima explains.
They all tell of the time Fahima returned home from university having had no food and seven cups of coffee. When her mother saw her quivering hands and head, studying was banned for the rest of the day.
'You wish you could have gotten that punishment,' Fahima shrugs.
She is used to the ribbing. 'You see my house,' she says later. 'Everyone's partying. I had to put those A's in front of me, to say, 'This is my focus.' '
It has been that way since she was six years old, still living in the UAE, and announced to her mom she wanted to be a doctor. 'God willing,' her mother answered, 'you will be.'
But like other children of immigrants, Fahima and her siblings now have an added motivation. They are the so-called second generation – who account for one in five Canadians in their 20s and who, despite lower family incomes, language barriers and less-educated parents, are outpacing their more settled Canadians peers in the race for higher education.
According to the 2001 census, members of visible minorities in their 20s born in Canada but with parents from other countries were almost twice as likely to have a university degree as third-generation-plus white Canadians. Even those who arrived in the country young had higher levels of school attendance, and a higher presence in high-skilled occupations.
They get an extra push from their working-class parents, who do not want their sacrifices to be wasted. 'It's not an accident that we are here,' Hodan says. 'We have a prophecy to fulfill.'
The Osmans arrived with some advantages: They were not burdened with the first-hand trauma of war, and they had learned some English in school, which they perfected watching soap operas and The Simpsons. But there was little money. Fahima took a paper route at 11 to help with the bills, and when they got jobs as teenagers, the older children helped cover the cost of clothes and school trips for the youngest.
At home, they had to tutor each other, and at school, they had to be their own advocates, translating for their mother at parent-teacher meetings (which, Hodan observes, had certain advantages).
But Fahima and her siblings all say they felt diminished by a school system that too easily slotted black kids into lower-level courses; this, they say, is the subtle form of racism they have experienced in Canada.
'You think, okay, people don't expect much of me,' Hodan says. 'I am going to use that to my advantage.'
Fahima cannot name a single high-school teacher who inspired her toward medicine, but she does remember a Grade 10 biology teacher announcing to the class how impossible it was to become a doctor: 'Do you think I'd be here if I'd made it?'
She also remembers the guidance counsellor who looked at her low mark in calculus and refused to let her take the course over, suggesting that she was setting her goals too high.
Fahima was one of only two black students taking university-track courses, keeping her marks up while working part-time at a Hallmark card store and helping out at home. She stopped saying at school that she wanted to be a doctor, and Ms. Farah, who first met Fahima at 17, remembers her unhappiness.
She had looked within her community for doctors who could advise her and found none. 'She was losing her confidence,' she says. 'She is a genuinely kind person, but she bruises easily. She needed encouragement and she wasn't getting it in school.'
But her family pushed her forward, along with close high-school friends such as Sunita Chowmik, 22, another second-generation Canadian, who is now a teacher. After graduation, the two went together to York, where Fahima could always be found in her favourite spot, among the stacks near the second-floor balcony of the university library.
She made a practice of parking in the most expensive lot on campus to force herself to study past 11:30 p.m., when the attendant left and she wouldn't have to pay.
Her life, except for chatting in coffee shops or going to the movies (she loves goofy comedies like Dumb and Dumber), was all about studying.
'If I really wanted to pull an all-nighter,' Ms. Chowmik says, 'I'd stay with her.'
That night, after the Sunday dinner at the Osmans, Fahima's brother Mohamed sends an e-mail. He is worried, he writes, that in all the funny stories, the truth did not get out – that Fahima has also been the generous big sister who helped mediate between the parents, who helped all the siblings with homework and gave them a model to follow. 'I wanted,' he says, 'to do what she did.'
In the summer before she graduated from York, Fahima went back to Somalia, and had her eyes opened. She was already planning to apply to medical school, but her backup plan was to work for an aid agency. She talked her way into an unpaid internship, split between Save the Children and CARE International. It was not a perfect experience: Looking back, she says, she spent too much time in meetings, and too little time on the ground with people.
But not even her endless viewing of World Vision programming had prepared her for what she saw – the life she could have led, had fate gone a different way. She remembers starving children wandering the streets without clothes, and the lone hospital that was missing technical things such as medical supplies and equipment, and human things like curtains between the beds.
Clearest in her mind is one conversation she had with a young woman seven months pregnant, whom she met sipping water in the sunset at a roadside café. The woman said she was hoping for a daughter, because her three other daughters had all died before they reached their first birthday. There was something about the matter-of-fact way she said it that stunned Fahima; though Somali, she was seeing their world with Canadian eyes.
'It's something normal to them, losing their children,' she recalls. 'They have a word for it, iga saqeeruy.'
The woman told her how mothers were left to die when they could not produce the $40 in American money – or a necklace or bracelet in barter – for the cost of a cesarean section. Women had taken to starving themselves when they were pregnant, so that they could have easier births. She asked a doctor about it. 'It's gotten to the point,' he told her, 'where I am delivering skeletons.'
At the café, with the sun dropping in the desert, she told the woman about her plans to be a doctor. The woman leaned forward and said, 'You must come back. Once people get out, they forget to come back and help us.'
When Fahima got home, she worked harder than ever. 'I was so motivated to get into medical school. It was a lot of sleepless nights. When you know what your life would have been like, versus how it is now, you just have to work hard.' She told her family that if she didn't get in, she would keep applying until she was 55.
But of course, she did. Now in her second year, with one left to go, Fahima is aware of being unique. In a diverse class, with student backgrounds from around the world, she is the only African. But it has been that way at school for much of her life – and it has mostly come in handy. In a group of 128, people remember her.
It has even paid off in the operating room, where students stand for hours, their main official responsibility to hold organs out of the way of the scalpel, while the surgeons rapid-fire questions at them. 'You're the target,' she says. But in Fahima's case, they sometimes forget to quiz her because they are so curious about her background.
At McMaster, learning is done in groups, not lectures. Fahima says she had to get over being shy to speak in front of people, but now her class is a close group, who got together on Wednesdays to watch The Bachelor and vote on which bride-wannabe should be next to go.
On request, Fahima enthusiastically rhymes off a list of diseases that fascinate her, and makes the kind of statement that gets her teased at home: 'I really like reading about the acute abdomen.'
Her career goal has shifted from obstetrics to general surgery; her final decision will be based largely on what would be most useful in Africa. She plans to divide her time between practising in Canada, the country that trained her, and working in Somalia, the country that needs her badly.
She will never go to the United States, she says, no matter how much money she could make (and she will graduate with $100,000 debt in student and bank loans): 'I am Canadian first.'
But she strongly believes she has a duty to give up movies and ice-cold Cokes and go to the desert where there is electricity only half the day, the hospitals shelves are always empty and people die daily from medical problems she could solve. She has started a student group for international medicine.
Dr. Goffredo Arena, who was the resident on her surgical clerkship this spring, recalls Fahima as the first person he ever met who said she wanted to be a surgeon so she could travel to a developing country and help people.
'We're all brothers and sisters in the world,' Fahima says earnestly. '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.'
Her teachers and mentors see this as one of Fahima's greatest gifts. She has not forgotten her roots. While many of her peers come from privileged, educated families, she had to find her own role models outside of her community – and she understands the importance now of being one.
'She sees the world in a different way,' says Dr. Samantha Nutt, the executive director of War Child Canada, who has helped to coach Fahima through medical school. 'You just know she is going to accomplish great things.'
The envelope that arrived that day in June and changed her life is now stored carefully in a file folder, which travels everywhere with her. 'I look at it every time I get frustrated, to remind me how much I wanted to get in.'
And to remember why.
20 years ago, a little girl in Somalia wanted to become a doctor when she grew up. Yesterday, Fahima Osman became the first Canadian-trained MD of the country's largest African community
When Fahima Osman was 6, she vowed to her mother that she would become a doctor.
'God willing,' her mother had answered, 'you will be.' It was, then, the wide-eyed boast of a little girl, who did not know that her family would end up fleeing to a new country as Somali refugees five years later, spending their last penny on the trip, abandoning their every possession, but for a few bags and a framed wedding picture.
But the dream held – through all-night study sessions squeezed between part-time jobs to help pay the bills, against the high-school teachers who doubted her, even when she looked around and realized that she would be the first.
For 20 years, the dream held.
Yesterday, with her parents and cousins and eight siblings watching from the audience at Hamilton Place, Fahima Osman stood with her classmates from McMaster University in Hamilton, Ont., and recited the words of the Hippocratic oath to make it official: she is now the first Canadian-trained doctor of the country's largest African community.
'She is famous,' said Abdi Osman, a program co-ordinator at Dixon Community Services in Toronto, which serves mainly Somali newcomers.
Mr. Osman (no relation) calls Dr. Osman 'a role model for the youth' of a refugee community that is still young and struggling, with an average adult income of about $15,000, according to the 2001 census. In the past decade, Somali Torontonians have formed outreach associations, started restaurants, celebrated the first wave of university graduates. But they have gone without a doctor who could speak to them in their own language, who understood their predominantly Muslim culture – until now.
'We congratulate her with our hearts. It is a great thing, to turn a refugee into a doctor. It is practical evidence that whoever wants to achieve the highest positions in this country can do so.'
In July, Dr. Osman begins her residency in general surgery at the Toronto General Hospital.
The residency is a five-year program for which, in true character, she had already begun studying, even before she had written her final seven-hour exam for medical school on Tuesday. 'I have to look at it as a journey,'' she said. 'I am just finishing one part, and looking forward to the next part.'
And planning, always planning, how she will make her mark – both in Canada, the country that welcomed her family, and in Somalia, where the people so desperately need her skills.
Since The Globe and Mail profiled Dr. Osman last June as part of the New Canada series, her story has been told and retold on Somali websites around the world. She once Googled her name, on a lark, and was shocked by the dozens of sites that bounced back with the details of her life – how her father, Adam, scrimped and saved his way out of the desert, and found work in the United Arab Emirates; how the young family came to Canada after his job ended because they could not go home to civil war; how the nine Osman children were told, no matter how tight the budget, they were expected to get a 'brand-name'' education. And setting the course, as the eldest, was Dr. Osman, with her relentless work ethic, and compassion.
'I am feeling fantastic,' her father said of her graduation. 'Her title is now Dr. Osman. It is a long way to come.'
'It is a dream, finally,' sighed her mother, Zahra, who first pulled the bulging McMaster envelope from the mailbox, under the noonday sun on June 4, 2000. She has gotten used to being introduced around the city as Dr. Osman's mother.
When she was first interviewed last year, Dr. Osman expressed her disappointment with not being able to find a mentor; she was promptly contacted by Andy Smith, the head of general surgery at Sunnybrook and Women's Hospital, who has become a close adviser. 'I was struck by her dynamism and focus,' Dr. Smith said. 'In many ways, she is emblematic of all that is right in this country.'' Flooded by e-mail, she is currently in regular contact with about 75 young immigrants, many of Somali origin, who are hoping to follow her path into medical school. She typically spends one day of each weekend, just responding to e-mail. Their questions, she says, sound so much like the ones she had when she was first trying to get in.
'When you see the competition, you feel so hopeless, you just want to give up,' she recalls. 'I wanted to show them that I am just an average girl, I worked hard and I got in.'
But what really got Dr. Osman thinking was a letter she received from her 10-year-old cousin back in Somalia, who told her that he would also like to be a doctor some day. 'The thing is,' she says, 'it is impossible for him, really. There are no medical schools there.' So Dr. Osman plans to split up her residency with a year-long masters degree in medical education or a related program so that she can work at a teaching hospital, and share her knowledge during regular stints back in Somalia.
She has a new dream now: that some day, she might see the opening of Somalia's first medical school.
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 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.
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 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.