I continue to be struck by the generosity, kindness, and creativity demonstrated as we soldier on through this pandemic. And my heart goes out to everyone, as we manage our changed lives. The situation is constantly evolving and has proven to be multifaceted in its consequences, and we won’t know for a while the extent of the long-term impacts. Bottom line: the keywords are flexibility and resilience.
One of UCSF’s immediate measures toward resilience was expanding our work-from-home guidance. With many researchers and educators as well as administrative employees tapping into VPN, not only did it stretch the UCSF bandwidth, it probably stretched your patience, too. To help relieve the stress, IT has fast-tracked its launch of Microsoft Office 365. For questions and support, check the Frequently Asked Questions or email [email protected].
Likewise, Expresso goes on…and this month I’m sharing with you three stories that were written pre-shelter-in-place – a journey I and others took with Glide Memorial Church on a pilgrimage to Alabama, a week of celebrating International Women’s Day, and progress in our efforts to improve people’s health and reduce health disparities through clinical trials.
- Diversifying Medicine: Gaining trust within underserved communities
- Celebrating, Empowering, and Inspiring Women: UCSF marks International Women’s Day
- Reflections: The UCSF/GLIDE pilgrimage to Alabama
Our current situation isn’t going to end very soon. Remember, it’s not a sprint, it’s a marathon – more an ultramarathon on a highly technical course that requires patience, agility, tenacity, endurance, and speed. It also calls for compassion – for others and ourselves. Why not try Mid-Day Mindfulness – A Peaceful Pause for All Staff, Faculty, and Learners at UCSF, sponsored by UCSF Spiritual Care Services and the Caring for the Caregiver Program (every weekday, 12 – 12:15 p.m.)?
Also, please join the UCSF Day of Remembering on May 15, 3 – 4 p.m. The virtual service will include reflections, readings, and rituals to offer comfort and support to the UCSF community: patients, caregivers, family, friends, faculty, and staff.
To your health,
Diversifying Medicine: Gaining trust within underserved communities
One of the most important ways we can make progress in our efforts to improve people’s health and reduce health disparities is to ensure that the clinical studies our scientists conduct reflect the broader population. As our colleague Tung Nguyen, professor in the Department of Medicine, explains, 60 percent of Californians are nonwhite, and by 2045, white people will become a minority nationwide. “A study that doesn’t have 60 percent minorities in it is a bad study,” Tung says. “Our investigators need to understand: This is no longer optional.”
For too long, medical studies have been conducted by white people on white people. “Therefore, whatever the findings, they could never apply to everyone,” explains Tung. “That perpetuates not only research disparities, but clinical treatment disparities too.”
Tung and others are leading efforts at UCSF to make sure that our studies cast as diverse a net as possible and also involve several key components to reflect the diversity of our population, including:
- A new infrastructure at the Clinical and Translational Science Institute (CTSI) to help researchers include diversity as part of their studies – similar to how the Institutional Review Board ensures studies are equitable and ethical. And we don’t expect investigators to do that work themselves. “We should also approach research enrollment as a job the institution does,” Tung says.
- Researchers need to hire more study personnel from diverse backgrounds, who can help recruit subjects from different communities.
- Research participant recruitment websites and materials need to be available in multiple languages and depict people of different ethnic and cultural backgrounds.
- We need to build bridges of trust, recognizing that people from underrepresented communities are justifiably skeptical of the medical establishment due to historical wrongs like the Tuskegee study and the story of Henrietta Lacks.
I’m certainly glad we already have a few initiatives that will help us achieve those goals.
One is the SF BUILD program, a partnership between UCSF and San Francisco State University that trains underrepresented students for careers as clinical research coordinators. In addition, last year my office provided funding to form an advisory board with community representation. Participating groups include the Chinese Community Health Resource Center, the Rafiki Coalition for Health and Wellness, the Instituto Familiar de la Raza, and the Central American Resource Center. Tung says these community leaders are partnering with UCSF to increase our diversity in clinical trials, and they also want UCSF to be a national model.
Wylie Liu, director of UCSF’s Center for Community Engagement, says that underrepresented populations view us as people in ivory towers who have harvested their information and published our reports, while the advances never make it back to their communities. They say, “Our lives have not been changed by what you learned from us.”
“We need to lay down that foundational relationship,” Wylie says. Perhaps a truth and reconciliation model, like the one that South Africa used, or that I learned about at the Equal Justice Initiative in Alabama last month, could help build trust.
Paula Fleisher, an associate director of the Center for Community Engagement (and a fellow participant in the recent trip to Alabama), cites the work of ASPIRE, a program funded by the federal Patient-Centered Outcomes Research Institute (PCORI). ASPIRE stands for Accelerating Systematic Stakeholder, Patient, and Institution Research Engagement.
“We had in-depth discussions about what we need to do at UCSF to do this work better,” Paula says. “We found out some difficult truths about where we’re falling short and where there’s promise. We got the message that we can’t really move forward until we’ve dealt with the history that under-resourced communities and communities of color feel a great affront by the University. There’s a lot of cynicism and distrust about our research – why we’re doing it and for whom. We can’t expect folks to step up if we are not stepping up,” Paula says. “We need to address them holistically and in a trustworthy way.”
“For example,” she adds, “who do we hire on our research teams? How do we train our researchers? In what language do they conduct their research? Whose research questions are we answering? Do we ask and not give in these research relationships?”
As we grapple with these important questions, we will come closer to our goal of achieving health equity and advancing health for everyone…and we’ll do it based on trust.
Postscript: This story was written pre-COVID-19. As the pandemic continues, we are gaining greater insight into its dynamic impact. Initially regarded as an equalizer, it clearly is not. COVID-19 is hitting underrepresented populations extremely hard and disproportionally, making the need for work like the Center for Community Engagement’s all the more apparent. To hear more about the impact, tune into the April 22 Office of Research and April 24 COVID-19 virtual town halls.
Celebrating, Empowering, and Inspiring Women: UCSF marks International Women’s Day
Just prior to the unprecedented worldwide disruption of COVID-19, the team behind the super successful celebration of International Women’s Day at UCSF in 2019 ambitiously looked to raise the bar in 2020.
This year’s festivities ran for a full week and across four campus sites, with nearly 1,000 people registering for more than 40 events. (At that link, you can see the amazing speakers, as well as links to video.)
The organizers wanted to celebrate, empower, and inspire women at UCSF to reach new heights, while at the same time confronting some of the challenges that face women, such as equal pay, sexual harassment, and the persistent glass ceiling. They also made the event even more inclusive, including perspectives of different ages and races, welcoming all genders, and convening panels of interest to staff and faculty.
Larisa Kure, associate dean for administration and finance in the School of Dentistry and staff co-chair of UCSF’s Committee on the Status of Women, one of the sponsors of the event, says many sessions offered valuable career advice. (The committee also has lots of useful career resources on its website, by the way.)
She cites one session on finding a sponsor, which is the next level up from a mentor and can be critical in a professional career. “A mentor may help you, guide you, and give you advice and a little bit of exposure,” Larisa says. “A sponsor takes the next step. She’ll put you forward, maybe use her own political capital to help you gain your goals. It’s more of a partnership.” She further explains that you don’t want your sponsor simply to be a top person in the field, but that it’s more important to find someone with whom you share an overlapping interest in science or other aspects of academics, as well as a similar outlook and values. You want a sponsor who will share information, be accessible, and help promote and protect her protégées.
At a “fireside chat” in front of more than 70 people in the library on Parnassus, two leaders from UCSF Health – Vice President of administration Cynthia Chiarappa and Chief Strategy Officer Shelby Decosta – took another tack and gave a range of practical and inspiring advice. “If you want to move forward in your career, don’t say ‘no,’” Cynthia said. “Look for opportunities to just do something. That’s how I advanced in my career. I did things outside of my job requirement. Say, ‘Yes, I’ll do it,’ and then figure out how to do it.” By the same token, she encouraged attendees to focus on their “personal Kanban,” a concept derived from the same Lean protocols that I wrote about last month, in which you prioritize your work, focus on getting things done before moving on to new things, and replenish yourself.
Unfortunately, women don’t always want to help other women. Shelby gave a pep talk: “If you get advice that’s discouraging, don’t give up,” she said. “Don’t let that discourage you from what you believe in. There are other resources.”
- Diversity: An inspiring panel of diverse leaders – Kirsten Bibbins-Domingo, vice dean for Population Health and Health Equity in the School of Medicine; Alejandra Rincón, assistant vice chancellor and chief of staff, Office of Diversity and Outreach; and Janhavi Bonville, associate EVCP – told their personal stories of resilience. While many of us knew these successful and high-profile women, we didn’t necessarily know the hurdles they had overcome in their careers.
- Elderhood: Nerissa Ko, a neurointensivist and faculty co-chair of the Committee on the Status of Women with Larisa, took particular inspiration in the speech from our own Louise Aronson, a national expert on aging and author of the book Elderhood. “We’ve talked about family-friendly policies that enhance the UCSF workplace for men and women who have young families, and we often forget the challenges – of women in particular – as they have to take care of an aging family member or transition themselves into ‘elderhood,’” Nerissa says. “We really don’t pay attention to the needs of growing into an older adulthood, and we don’t really put the right kind of attention, both as a health system and as a society, into the needs of those who are in elderhood.”
- Overcoming obstacles: Kim Murphy, an event planning dynamo at UCSF Health and another of the organizers, found motivation in the story of keynote speaker Dilruba Malik, who moved to the US with her family at age 20, barely speaking any English. Forced to become the family’s breadwinner, Dilruba started in minimum wage jobs, got an education at Georgia Tech, and has worked her way through the ranks at Cisco, becoming a leading engineer in Silicon Valley.
Larisa, Nerissa, and Kim appreciate the vital support from Renee Navarro, vice chancellor of Diversity and Outreach, and Sheila Antrum, senior vice president and chief operating officer of UCSF Health. Overall, Nerissa says, the event served to strengthen the community of women at UCSF. “Our goal was to really build that community,” she says, “and to demonstrate the continuing need to show there is a vibrant community that supports women at UCSF, so that each can reach her highest potential.”
The week was a resounding success.
Fast-forward to today, as the impact of COVID-19 seeps into every aspect of our lives. Despite the mass entry of women into the workforce during the twentieth century, the phenomenon of the “second shift” still exists, and it’s been magnified during the pandemic. Across the world, women – including those working outside the home – do more housework and have less leisure time than their male partners. Women are more often than not the chief health care officer, chief entertainment officer, and chief education officer in the home, all while remaining a high-performing employee and being a reassuring mom during a global crisis. Looking through the gender lens with this renewed awareness, we have an amazing opportunity to catalyze – not compromise – further progress toward gender equality at UCSF. When women succeed, we all succeed.
Reflections: The UCSF/GLIDE pilgrimage to Alabama
The rain is pelting down from the dark gray and black cloud-covered Montgomery sky, and I find myself in a place I never knew existed. Row upon row of rectangular metal columns, resembling elongated coffins, are suspended vertically from the roof of a giant square structure that creates a perimeter with a central open space. The walk around the square, which today is met with billowing sheets of water along the discontinuous walls, follows a path that ever so gradually descends, so that the hanging metal columns, 800 in all, appear to slowly rise up to the heavens. This walk, through the National Memorial for Peace and Justice, is an immersion into a forgotten part of our history – the lynching of more than 4,400 black people between 1877 and 1950. Each column in the memorial represents a U.S. county, and the names of the victims in each county are inscribed on the columns. The wind and the darkness and the lashing rain, and the name after name after name, consume me with sorrow.
This experience in Montgomery, during the first week of March, was one of many I shared with a contingent of 17 UCSF faculty and staff who joined members of the Glide Memorial Church community for the annual Truth, Justice, and Reconciliation Pilgrimage sponsored by Glide’s Center for Social Justice. We spent time in Birmingham, Selma, and Montgomery, seeing historic sites such as the 16th Street Baptist Church, the Birmingham Jail, and the Pettus Bridge; meeting with health care colleagues at the University of Alabama and J. Paul Jones Hospital (located in the poorest county in Alabama); and visiting truly unforgettable sites designed to convey the history of racism in Alabama, most notably the Legacy Museum in Montgomery, a brilliant creation by Bryan Stevenson and the Equal Justice Initiative. Rabbi Michael Lezak, one of the leaders of the pilgrimage, warned us that at some point in our journey we would be brought to our knees in anguish, and he was right. How could this not happen when coming face-to-face with the blood-soaked reality at one of the epicenters of our nation’s history of slavery and racism? But the more important outcomes of the pilgrimage were a deepened understanding of the roots of racism in America today, a further opening of our eyes to the racism and injustice here in the Bay Area, and an unambiguous commitment to being forces of change.
As I mentioned above, this pilgrimage is planned to be an annual event, so I encourage you to take this journey next year. I’ll circulate details on signing up when they become available.
There’s much more to this story, so I invited some of my fellow pilgrims to share their thoughts…
Our journey has reiterated my impression that the artificial, irrational, internal forces inside us all that we construct to maintain our own self-interest and status quo are typically stronger than the drive towards justice. Extraordinary leaders such as Dr. Martin Luther King Jr., Bryan Stevenson, Fred Shuttlesworth, and the foot soldiers of the civil rights movement may be able to slow the tide of slavery, mass incarceration, and wealth disparity, but unless we are vigilant, self-aware, united, and prepared to sacrifice, we construct a world where we believe that plantations were not built by slaves and where it is normal to gather in town squares to celebrate the mutilation of a human being and where thousands of people sleep on the streets of San Francisco tonight. It is a bleak and uncomfortable vision. And yet, when we gather in fellowship, the joy and uplift that can come when we gather in song, hope, and wonder feels greater and more powerful than the evil that drives us apart.
I am fascinated by the concept of holding space. I won’t go too far down the rabbit hole of what that means to me, but simply put, I believe it has a lot to do with intention. In this case, an intention to create an environment by which we can see one another for who we truly are, exposing what hides behind the labels that define our identities – judgments. This is the place where people can be free, vulnerable, and honest. Luminous transparency. It is a hard space to create. It requires sacrifice and a willingness to step into that “uncomfortable space.” This is what I believe compassion is. All of you demonstrated a deep understanding of this throughout our trip. You give me hope. Our pilgrimage was one of the most important experiences of my life.
Thank you for holding space with me.
Joshua Fears, RN
San Francisco Department of Public Health
I knew being immersed in the painful history of my people would be difficult, and as Maya Angelou once said, I had to have the courage to do it. I was grateful to have colleagues there to support me in this pilgrimage.
It was inspiring to hear the words and stories directly from those who marched, protested, and survived. They told their stories not in anger or hate, but in strength. They showed pride in their community and love for others, even their oppressors and imprisoners. By documenting and acknowledging the hate that is deep in the soil, we start to repair and give truth to what really happened on the land. While Washington politicians were marching in Selma, we walked on the soil of a plantation turned into a B&B. This sparked a powerful conversation.
I can no longer stay silent or unaware. I, we, must give voice and light to the ways that slavery, Jim Crow, the drug war, and mass incarceration are greatly impacting us in our work at UCSF in our day-to-day lives. The health care inequities we see every day are a consequence of the untruthful narratives and unrepaired atrocities that take the lives of my people at too young an age.
I come home more inspired to speak up and document the truths I see. I come home more inspired to continue the work of opening myself to be more aware of the humanity around me and listen to each of their stories and voices. I come home more inspired to do my life’s work of diversifying the pipeline to reflect the diversity of our patients.
I’m very grateful for the impactful experiences we had in Alabama, for the amazing people we met there, and for the generosity of spirit and wisdom you shared.
I don’t feel that I can possibly capture what I want to say in a few sentences but here goes…I joined the Alabama pilgrimage to gain a greater understanding of the social and historical roots of disparities in our country. I left with a deeper appreciation of ongoing inequities and also the unimaginable resilience of people who rise above the many indignities they’ve endured through generations of slavery, Jim Crow laws, mass incarceration, and so much more. The Freedom Fighters and others we met powerfully inspire and challenge us to confront the hard realities of racism in our time. How in 2020 do we have rural communities in Alabama where African Americans live without running water or septic systems and where hookworm is still endemic? How do we reconcile the disproportionately high number of African Americans in our own city’s homeless population? Why are our educational, health care, and justice systems failing black families? What is my role as an ally and advocate to use my privilege to address these inequities? These are a few of the poignant realities that demand my attention as a physician and concerned citizen and that renew my commitment to work for justice.
While this is my second journey of its kind, like many of you, I’ve been on a lifelong journey toward justice. And like many of you, this trip still altered me.
Perhaps the greatest lesson for me was that the civil rights movement was not referred to as such by those on its frontline; each of those elder women told us they were “foot soldiers”– not protesters or activists. And they told us they were part of the Freedom Movement, not a struggle for civil rights. That’s meaningful to me. They have been fighting for all our freedom. And they’ve put their lives and safety on the line to do it. They made me feel deeply challenged to do more, and to be more courageous than I have been. Like Renee, I feel affirmed that we must be willing to speak truths, with courage.
Your encouraging and supportive words and hugs helped. I do, however, continue to feel vulnerable, having spoken my truth so publicly. I don’t expect that to change. I’m willing to accept that. It is a small part of what I think it takes for us to collectively move forward. I’m willing to take the risk that comes with it. I know it’ll take much more than bold statements, and I am committed to staying engaged in the hard work, long term, with all of you and the rest of our colleagues.
While I hope my actions show it without it being said, I do want to say this: I believe we are all a human family, relatives. We are all connected. Race is a social construction that burdens us all.
My heart is shattered, my mind opened, and my perspective changed forever. For this I am grateful.
Having grown up in South Carolina, I was reminded at every turn of the road of the lies (of commission and omission) in my own education. I sadly recognize the limitations of my judgment because of the white supremacy ideology that has and still pervades every aspect of our society, especially in its centers of power. This belief system powerfully reinforces the status quo, advantaging me while harming so many people of color.
Walking in the historical footsteps of Freedom Fighters from the Brown Chapel AME Church to the Edmund Pettus Bridge, we passed many images of civil rights leaders. I found this Dick Gregory quote compelling: “Love is man’s natural endowment but he doesn’t know how to use it. He refuses to recognize the power of love because of his love of power.”
I return home with the belief that those of us with power based on our positions, influence, race, gender, and other privileged characteristics must truly open our hearts to the power of love for all and accelerate our efforts to create a more inclusive, equitable, and just UCSF, SF, and beyond.
We must embrace the discomfort of diverse perspectives and lived experiences and recognize the need for tension if we are to make progress – a tension that Dr. King spoke eloquently about in his letter from the Birmingham Jail.
We must be vigilant to avoid acting on our learned racism and its inherent bias to maintain the power of the status quo. I loved the concept articulated by Jasmyn Elise Story in Birmingham. She told us she looks at every problem and possible solution through the lens of domination and asks which voices are not at the table that should be. We must ask the same thing and in addition ask the question of whose voices are not being heard even when they are at the table?
I commit to the musts listed above and ask you to hold me accountable for these and other issues and behaviors as we explore specific solutions and actions together.
I am immensely grateful for this journey with all of you, for the guidance of Rabbi Michael and Isoke [Femi], for the music of Vernon [Bush] and for the inspiration, strength, and generosity of all we were blessed to meet.
It is my hope that with our deepened shared values, better understanding of white supremacy, recognition of the power of love for all, and higher sense of urgency, we can make progress in eliminating the harms of racism, power, and privilege in our communities and honor the dignity and potential of all.
The experience was both powerful and painful. While the history was well-known to me, the opportunity to more tangibly feel the land and hear from the people was eye-opening and life-altering. I take several important lessons from this experience:
- We must tell the truth. The truth of our American history of slavery, Jim Crow segregation, white supremacy, and the ongoing impact of racism on higher education, health, health care, job opportunities, education, and the criminal justice system, as well as the impact on homelessness within our city.
- We must have courage. To stand up against current systems that facilitate the status quo. To be Pro-Black, and not just anti-racism.
- We must not leave this work to the black people alone – when others show up to improve your life, it’s a powerful message regarding the humanity of all of us.
While I have “known” about inequities and conducted research on health disparities, I return struck by the visceral reality of health and public health inequities within the U.S. and how the legacy of racial injustice permeates our everyday lives and assumptions. In my work at UCSF, I know that I am often too “comfortable” and reluctant to challenge others or myself. The uncertainty and stakes were so high for those children marching in Birmingham in 1963 or those who marched from Selma to Montgomery in 1965 (as well as so many others), yet they marched. I need to be willing to confront the truth in front of me and the deception that I am a part of. As we heard the words of Dr. King shared at our closing morning at the Southern Poverty Law Center: “In the end, we remember not the words of our enemies, but the silence of our friends.”
Dan’s Tip of the Month
Last month, The Atlantic published “The Pre-pandemic Universe Was the Fiction” by Charles Yu, which adds another insightful layer to what is already an intense existential struggle for many of us. It describes what has become apparent within weeks of our lockdown – our previous way of life was an imagined reality in which we perceived that, as a species, we had overall control of our destiny. And Yu continues with a sobering reminder, “Things aren’t necessarily going to be okay in a reasonable timeframe just because we want them to be. To think otherwise is to succumb to the fiction, a sheltered, resource-rich mindset (presumably not shared by the billions of people who have long lived in volatile conditions and are thus under no such illusions).” But the pandemic has demonstrated that our assumed powers are no match for something far greater – Mother Nature. Yu offers a prescription – cooperation and humility – as key to our survival. I would go one step further and say we will need more than old imaginings to rebuild, recover, and find our way out. We need re-imagined structures based on compassion and support for everyone’s well-being. The stakes are high.
Illustration: Hannah Whitaker