The Visible Voices

Jenna Lester and Susan Chon Skin Color Program and Representation in Dermatology

We Need More Illustrations of People of Color in Medical Textbooks— The lack of diversity perpetuates health inequality and stereotypes"The consequences of primarily depicting White, lighter skinned individuals with Eurocentric features in medical images supports the persuasive concept of White supremacy. It perpetuates the belief that the White male body is "the standard" to which all other bodies should be compared. It leads to inequality in medical education and further perpetuates harmful stereotypes of Black individuals. As a result, this issue plays a role in inappropriate diagnosis and health management of Black individuals. Furthermore, medical care becomes subjective, discriminatory, and filled with speculatory assumptions based on stereotypes."Jenna C. Lester is founder of the Skin of Color dermatology program at UCSF, which addresses the  persistent issues that arise from the exclusion and marginalization of non-white patients in medical  research and practice. She is combatting medical disparities due to racial inequality, working to fill education gaps in textbooks and curriculum about non-white skin and training a new generation of  doctors. A graduate of Harvard University and The Warren Alpert Medical School of Brown University, she is an assistant professor of dermatology at UCSF where she practices and teaches general dermatology.Jenna's TedX TalkSusan Y. Chon, a 1991 Brown graduate with an independent concentration in children’s literature, is a professor in the Department of Dermatology at the University of Texas M.D. Anderson Cancer Center. Prior to joining the faculty, she earned her M.D. from Stanford University School of Medicine. She then completed her internship in internal medicine and her dermatology residency at Stanford University Hospital. Chon specializes in treating patients with skin cancers, melanomas and skin disorders from cancer treatments. She is a medical educator and an active mentor for medical students and dermatology residents. She is also director of the Skin Cancer Screening and Prevention Program and founded the volunteer physician program for the Brookwood Community, a residential and vocational program for adults with disabilities. Chon is the president of the Brown Club of Houston, helping to maintain the connection between Brown and its graduates throughout the world, and serves as a member of the Women’s Leadership Council, Women’s Launch Pad and Philanthropy Advisory Group. Under-representation of skin of colour in dermatology images: not just an educational issue.Lester JC, Taylor SC, Chren MM.Br J Dermatol. 2019 Jun;180(6):1521-1522. doi: 10.1111/bjd.17608.PMID: 31157429 No abstract available. Clinical photography in skin of colour: tips and best practices.Lester JC, Clark L Jr, Linos E, Daneshjou R.Br J Dermatol. 2021 Jun;184(6):1177-1179. doi: 10.1111/bjd.19811. Epub 2021 Mar 18.PMID: 33448346 No abstract available. Integrating skin of color and sexual and gender minority content into dermatology residency curricula: A prospective program initiative.Jia JL, Gordon JS, Lester JC, Linos E, Nord KM, Bailey EE.J Am Acad Dermatol. 2021 Apr 16:S0190-9622(21)00816-1. doi: 10.1016/j.jaad.2021.04.018. Online ahead of print.PMID: 33872717 No abstract available.Two pandemics: Opportunities for diversity, equity and inclusion in dermatology.Lester JC, Taylorf SC.Int J Womens Dermatol. 2021 Jan 17;7(2):137-138. doi: 10.1016/j.ijwd.2021.01.015. eCollection 2021 Mar.PMID: 33937478 Free PMC article. No abstract available.Encouraging the next generation of skin of color researchers: Funding skin of color research in medical school and residency.Jia JL, Amuzie AU, Lester JC.J Am Acad Dermatol. 2021 Sep;85(3):e161-e163. doi: 10.1016/j.jaad.2020.11.048. Epub 2020 Nov 27.PMID: 33253843 No abstract available.Skin Cancer in People of Color: A Systematic Review.Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML.Am J Clin Dermatol. 2021 Dec 13. doi: 10.1007/s40257-021-00662-z. Online ahead of print.PMID: 34902111BACKGROUND: People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES: In this study, we assess incidence, risk factors, clinical characteristics, histopathology,  Skin-of-color article representation in dermatology literature 2009-2019: Higher citation counts and opportunities for inclusion.Amuzie AU, Jia JL, Taylor SC, Lester JC.J Am Acad Dermatol. 2021 Mar 24:S0190-9622(21)00617-4. doi: 10.1016/j.jaad.2021.03.063. Online ahead of print.PMID: 33771597 No abstract available.Establishing the diagnosis of rosacea in skin of color patients.Onalaja AA, Lester JC, Taylor SC.Cutis. 2019 Jul;104(1):38-41.PMID: 31487335Rosacea is a chronic inflammatory cutaneous disorder that may be underreported and underrecognized in skin of color (SOC) patients. There are several skin disorders that can present with the classic features of rosacea, such as erythema, papules, and pustules, which …Absence of images of skin of colour in publications of COVID-19 skin manifestations.Lester JC, Jia JL, Zhang L, Okoye GA, Linos E.Br J Dermatol. 2020 Sep;183(3):593-595. doi: 10.1111/bjd.19258. Epub 2020 Jul 16.PMID: 32471009 Free PMC article.Mounting evidence shows that COVID-19 impacts several organ systems, including the s

Celine Gounder A Voice for Public Health Pandemics and Podcasting

Celine Gounder, MD, ScM, FIDSA, is a Clinical Assistant Professor of Medicine and Infectious Diseases at NYU Grossman School of Medicine. She cares for patients on the wards at NYC Health + Hospitals/Bellevue and at Indian Health Service and tribal health facilities across the country.Dr. Gounder is the CEO, President, and Founder of Just Human Production, a non-profit multimedia organization. Dr. Gounder is the host and producer of American Diagnosis, a podcast on health and social justice, and Epidemic, a podcast about the COVID-19 coronavirus.She's written for The New Yorker, The Atlantic, The Guardian US, The Washington Post, Reuters, Quartz, Sports Illustrated, and Bloomberg View. She’s a frequent expert guest on CNN, HLN, MSNBC, Al Jazeera America, CBS, BBC, MTV, Dr. Oz, and Oprah Prime. She’s best known for her print and TV coverage of the Ebola, Zika, COVID-19, gun violence, and opioid abuse epidemics.In early 2015, Dr. Gounder spent two months volunteering as an Ebola aid worker in Guinea. In her free time, she interviewed locals to understand how the crisis was affecting them. She is currently making Dying to Talk, a feature-length documentary about the Ebola epidemic in Guinea.Dr. Gounder is also a consultant for TEDMED and on TEDMED’s 2017, 2018, and 2020 Editorial Advisory Boards.Between 1998 and 2012, she studied TB and HIV in South Africa, Lesotho, Malawi, Ethiopia, and Brazil. While on faculty at Johns Hopkins, Dr. Gounder was the Director for Delivery for the Gates Foundation-funded Consortium to Respond Effectively to the AIDS/TB Epidemic. She later served as Assistant Commissioner and Director of the Bureau of Tuberculosis Control at the New York City Department of Health and Mental Hygiene.She received her BA in Molecular Biology from Princeton University, her Master of Science in Epidemiology from the Johns Hopkins Bloomberg School of Public Health, and her MD from the University of Washington. Dr. Gounder was an intern and resident in Internal Medicine at Harvard’s Massachusetts General Hospital and a post-doctoral fellow in Infectious Diseases at Johns Hopkins University. She was elected a fellow of the Infectious Diseases Society of America in 2016 and featured in the IDSA’s 2017 Annual Report. In 2017, People Magazine named her one of 25 Women Changing the World.Website: https://www.celinegounder.com/

Jennifer Freyd Kevin Webb Institutional Trauma Betrayal and Courage

Jennifer Joy Freyd researcher, author, educator, and speaker. Freyd is an extensively published scholar who is best known for her theories of betrayal trauma, DARVO, institutional betrayal, and institutional courage.Freyd is the Founder and President of the Center for Institutional Courage, Professor Emerit[ of Psychology at the University of Oregon, Adjunct Professor of Psychiatry and Behavioral Sciences in the School of Medicine,[Faculty Fellow at the Clayman Institute for Gender Research, Affiliated Faculty, Women's Leadership Lab, Stanford University, and principal investigator of the Freyd Dynamics Lab.Betrayal trauma Earlier this year, she settled a lawsuit she filed against the University of Oregon after learning that the university was paying her $18,000 less per year than male colleagues closest in rank to her. The university agreed to pay her $350,000 to cover her claims for damages and her attorneys’ fees and also agreed to donate $100,000 to the Center for Institutional Courage.Kevin Webb is a higher education training professional specializing in Title IX compliance and gender-based violence prevention, as well as equity and inclusion. Kevin has developed, implemented, and facilitated in-person and online training and education programs for students, faculty, and staff at large public and private universities, and produced a variety of education and awareness events around sexual assault and relationship violence prevention in collaboration with campus and community partners. Kevin has developed content for online Title IX/sexual misconduct training implemented by a cross section of American colleges and universities, and provided sexual harassment training for private organizations. Kevin has a Bachelor of Arts degree in Sociology and Organizational Behavior and Management from Brown University, where he served as a teaching assistant in sociology courses dealing with issues of race and social justice, and a Master’s degree in Public Administration (MPA) from the Baruch College School of Public Affairs, CUNY.In the news:Institutional betrayal Three graduate students file sexual harassment suit against prominent Harvard anthropology professor (Boston Globe)DARVO A high-flying German media giant is ahead on digital media but seems stuck in the past when it comes to the workplace and deal-making. Axel Springer (NYTimes)Women spoke up, men cried conspiracy: inside Axel Springer’s #MeToo moment (Financial Times)2018 NASEM Report  Sexual Harassment in Academic Science Engineering and MedicineThis study examined the prevalence and impact of sexual harassment in academia on the career advancement of women in the scientific, technical, and medical workforce. The report concludes that the cumulative result of sexual harassment in academic sciences, engineering, and medicine is significant damage to research integrity and a costly loss of talent in these fields. It provides a series of recommendations for systemwide changes to the culture and climate in higher education to prevent and effectively address all forms of sexual harassment.DARVODARVO stands for Deny, Attack, and Reverse Victim and Offender—a perpetrator strategy. The perpetrator may Deny the behavior, Attack the individual doing the confronting, and Reverse the roles of Victim and Offender, so that the perpetrator adopts the victim role and accuses the true victim of being an offender. This can occur when an actually guilty perpetrator assumes the role of "falsely accused" and attacks the accuser's credibility and blames the accuser of being the perpetrator of a false accusation.Institutional courage™Institutional courage is the antidote to institutional betrayal. It includes institutional accountability and transparency, as when institutions respond well to disclosures and when institutions conduct anonymous surveys of victimization within the institution and then use the data to become healthier.Betrayal blindnessBetrayal blindness, a key concept of betrayal trauma theory, is the unawareness, not-knowing, and forgetting exhibited by people towards betrayal. Victims, perpetrators, and witnesses may display betrayal blindness in order to preserve relationships, institutions, and social systems upon which they depend.Betrayal trauma A betrayal trauma occurs when someone you trust and/or someone who has power over you mistreats you. For instance, it’s a betrayal trauma when your boss sexually harasses you. Our research shows that betrayal traumas are toxic. They are associated with measurable harm, both physical and mental.Institutional betrayalInstitutional betrayal, developed from betrayal trauma theory, occurs when the institution you trust or depend upon mistreats you. It can be overt but it can also be less obvious, for instance, a failure to protect you when protection is a reasonable expectation. Our research shows that institutional betrayal is also related to measurable harm —again both mental and physical.

Ashley McMullen Storyteller and Human Doctor

Dr. Ashley McMullen is an assistant professor of medicine at the University of California, San Francisco and a primary care internist based at the San Francisco VA Hospital. She is a Houston, TX native and lifelong book nerd, who grew up nurtured by her mother, a pediatric nurse, and grandmother, an ordained minister. Dr. McMullen’s work focuses on the role of narrative and storytelling in medical education as a mechanism for healing, advocacy, and improving care across differences. She served as the host and producer of The Nocturnists: Black Voices in Healthcare Series, a 2021 Webby Award Honoree, and recently launched a new story-telling podcast with Dr. Kimberly Manning called, The Human Doctor. 

Ayanna Howard Dean of Engineering Roboticist and AI Expert

Accomplished roboticist, entrepreneur and educator Ayanna Howard, PhD, became dean of The Ohio State University College of Engineering on March 1, 2021. Previously she was chair of the Georgia Institute of Technology School of Interactive Computing in the College of Computing, as well as founder and director of the Human-Automation Systems Lab (HumAnS). Her career spans higher education, NASA’s Jet Propulsion Laboratory, and the private sector. Dr. Howard is the founder and president of the board of directors of Zyrobotics, a Georgia Tech spin-off company that develops mobile therapy and educational products for children with special needs. Zyrobotics products are based on Dr. Howard’s research. Among many accolades, Forbes named Dr. Howard to its America's Top 50 Women In Tech list. In May 2021, the Association for Computing Machinery named her the ACM Athena Lecturer in recognition of fundamental contributions to the development of accessible human-robotic systems and artificial intelligence, along with forging new paths to broaden participation in computing. Dr. Howard also is a tenured professor in the college’s Department of Electrical and Computer Engineering with a joint appointment in Computer Science and Engineering. As dean, she holds the Monte Ahuja Endowed Dean's Chair, which was established in 2013 through a generous gift from Distinguished Alumnus Monte Ahuja '70. She is the first woman to lead the College of Engineering, and the college’s second Black dean. Throughout her career, Dr. Howard has been active in helping to diversify the engineering profession for women, underrepresented minorities, and individuals with disabilities. Dr. Howard earned her bachelor’s degree in computer engineering from Brown University, her master’s degree and PhD in electrical engineering from the University of Southern California, and her MBA from Claremont Graduate University. From 1993 to 2005, she worked at NASA’s Jet Propulsion Laboratory, where she held multiple roles including senior robotics researcher and deputy manager in the Office of the Chief Scientist. Among other projects, Howard was involved in developing SmartNav — an autonomous, next-generation Mars rover — and SnoMotes, toy-sized robots that can explore icy terrain that is too dangerous for scientists. She joined Georgia Tech in 2005 as an associate professor and the founder of the HumAnS lab. The lab focuses on humanized intelligence, which uses techniques such as sensing and learning to enhance the autonomous capabilities of robots or other computerized systems. Among other roles at Georgia Tech, Dr. Howard was program director of the nation’s first multidisciplinary robotics PhD program; associate chair for faculty development in the School of Electrical and Computer Engineering; and associate director of research at the Institute for Robotics and Intelligent Machines. In 2013, she founded Zyrobotics to help translate the lab’s research into commercial products for children with special needs. Zyrobotics spun off as a non-profit in 2020.More on Ayanna Howard:Podcast: Enginuity podcast Book: Sex, Race, and Robots: How to Be Human in the Age of AIhttps://www.nasa.gov/vision/universe/roboticexplorers/ayanna_howard.htmlhttps://sloanreview.mit.edu/article/real-talk-intersectionality-and-ai/https://sloanreview.mit.edu/article/taming-ais-can-should-problem/https://sloanreview.mit.edu/article/diversity-in-ai-the-invisible-men-and-women/https://www.thehistorymakers.org/biography/ayanna-howard-41https://ny.pbslearningmedia.org/resource/5aa004f3-f0a8-40e7-8aea-1aa18aa9705d/5aa004f3-f0a8-40e7-8aea-1aa18aa9705d/ 

Joanne Epps and Serena Murillo: Lawyers Scholars and Advocates for Equity

JoAnne A. Epps is a Senior Advisor to the President at Temple University ,and a Professor of Law . A member of the Temple law school faculty since 1985, JoAnne Epps served as Dean of Temple’s Beasley School of Law from 2008-2016.  From 2016-2021, she has served as Executive Vice President and Provost of Temple University.  Author and co-author of several books and articles on Evidence and Trial Advocacy, Epps has won numerous awards recognizing her commitment to diversity and advancing women within the legal profession and community. Epps is a former Deputy City Attorney for the City of Los Angeles and Assistant United States Attorney for the Eastern District of Pennsylvania. Serena Murillo is a Judge of the Los Angeles Superior Court. She has presided over the court’s Criminal, Civil, and Appellate Divisions, and served as Justice pro tem on the California Court of Appeal.  She is a co-chair of the Los Angeles Superior Court’s Latino Judicial Officers Association and a professor at the University of California Irvine School of Law.  She serves as faculty for the California Judicial Council’s Center for Judicial Education and Research and speaks on issues pertaining to bias and gender-based incivility in the legal profession.  She is a recipient of the California Chief Justice’s Award for Exemplary Service and Leadership to the Judicial Branch..

Bob McNamara and Darin Wiggins: What Matters in Emergency Medicine

Robert McNamara, MD, FAAEM a Professor and Chair in the Department of Emergency Medicine and Lewis Katz School of Medicine at Temple University. He is the past president of the American Academy of Emergency Medicine and currently Chief Medical Officer, AAEM Physician Group. He received his medical degree from Jefferson Medical College in 1982 and then completed his residency in Emergency Medicine at the Medical College of Pennsylvania.  He stayed on as faculty at MCP and was the residency program director until he departed for Temple University School of Medicine in 1999.  At Temple, Dr. McNamara along with his faculty was successful in the creation of a full academic department of EM in 2001 and he currently serves as Chairman at Temple University Hospital, the busiest Level 1 Trauma center in the Delaware Valley.  His scholarly contributions include over 100 peer reviewed articles and abstracts and numerous textbook chapters.  He was involved in the first studies bringing intra-osseous infusion and magnesium therapy for asthma to attention of the EM community.  Nationally, Dr. McNamara is a leading figure in the specialty of Emergency Medicine.  He has been active in leadership roles within a number of medical societies but is best known for his achievements as a founding member of the American Academy of Emergency Medicine (AAEM).  Dr. McNamara served as AAEM’s President from 1996 until 2002. Under his leadership the organization gained national and international stature while representing board certified emergency physicians.  In 2015, he became the Chief Medical Officer of the newly created AAEM Physician Group which seeks to preserve physician-owned practices in Emergency Medicine. Dr. McNamara currently serves as the Premier Open Coach of the US National Dragon Boat Team. Teams under his direction have won 135 medals at the World Championships. Dr. McNamara was born and raised in Philadelphia and currently resides in Lafayette Hill, PA. Follow Bob on twitter and LinkedInDarin G Wiggins MD is the vice chair Department of Emergency Medicine Stony Brook Southampton Hospital. He is the chair of the physician leadership committee Stony Brook Southampton Hospital.

Aletha Maybank Chief Health Equity Officer for the American Medical Association

Aletha Maybank, MD, MPH currently serves as the Chief Health Equity Officer and Senior Vice President for the American Medical Association (AMA) where she focuses on embedding health equity across all the work of the AMA and leading the Center for Health Equity. She joined the AMA in April 2019, as their inaugural Chief Health Equity Officer. Dr. Maybank previously served as Founding Director for the Center for Health Equity at the NYC Department of Health and Mental Hygiene (2014) and the Office of Minority Health in the Suffolk County Department of Health Services (2006). She is a nationally recognized speaker, writer and advisor on issues related to health equity, the future of medicine, and public health impact. She received her Bachelor of Arts from Johns Hopkins University, a Medical Degree from Temple University School of Medicine, and a Master of Public Health from Columbia University Mailman School of Public Health.AMA Health Equity PublicationsOrganizational Strategic Plan to Embed Racial Justice and Advance Health EquityAdvancing Health Equity: A Guide to Language, Narrative and ConceptsDr. Aletha Maybank: A Commitment to Advance Health Equity on YouTubehttps://www.youtube.com/watch?v=nOUB6QFsr1kPrevalence of Personal Attacks and Sexual Harassment of Physicians on Social Media

Delphine Huang and Gyles Morrison on IDEO, Health Design, and Clinical Ux

Health design thinking uses play and experimentation rather than a rigid methodology. It draws on interviews, observations, diagrams, storytelling, physical models, and role playing; design teams focus not on technology but on problems faced by patients and clinicians. Healthcare UX, then, is about the experiences people have with healthcare technology and services. A Healthcare UX designer’s job is to optimise the usability, accessibility and pleasure of healthcare technology and services. Remember, the experiences cannot be guaranteed, but they can be influenced. Clinical UX, a niche within Healthcare UX focused on the experiences clinicians and their patients have with healthcare technology and services.Dr. Delphine Huang is a medical director at IDEO Health. She works closely with design teams to bring impactful and innovative ideas to life. Her projects span from health products, services, systems and strategy design. She is also a practicing emergency medicine physician and loves hiking the California coast, finding the perfect avocado, and continuously learning from her kids.Dr Gyles Morrison is a Clinical UX Strategist with a 10 year history in healthcare. Starting as a doctor in the UK, he now works internationally, helping UX professionals and healthcare companies make products and services that are valued by clinicians and patients. His areas of interest are digital therapeutics, healthcare behaviour change, UX maturity and professional development.             https://drgylesmorrison.medium.com/what-is-healthcare-ux-and-why-is-it-so-important-be21b415e681Health design solutions to improve the care of sickle cell patients with vaso-occlusive crisis in the emergency department https://www.youtube.com/watch?v=Am5jIA7xKJUhttps://drgylesmorrison.medium.com/how-to-learn-clinical-ux-through-mixed-learning-fbf147a42875TranscriptSUMMARY KEYWORDSdesign, people, Gyles, clinician, healthcare, IDEO, health, ux, moments, patients, thinking, resistance, therapeutics, clinical, digital, working, Delphine, opportunities, shared, projectsSPEAKERSResa Lewiss, Delphine Huang, Gyles MorrisonResa Lewiss  01:12Hi, audience. Thanks so much for joining me. And we're talking about a favorite topic, health design and user experience by two guests or subject matter experts in after balancing a few calendars, a few continents and a few time zones. Here we are. Dr. Delphine Huang is a medical director at IDEO health. She works closely with design teams to bring impactful and innovative ideas to life. She's a practicing emergency physician at San Francisco General in San Francisco, and her projects span from health products, services, systems and strategy design. Dr. Gyles Morrison is a clinical UX strategist. He has a 10 year history in healthcare, and he started as a physician in the UK, yes, the United Kingdom. He now works internationally helping UX professionals and healthcare companies make products and services that are evaluated by clinicians and patients. So each of these physician health designers have websites and have lots of projects. I first met Delphine, when I was reading about design and Health Design, and the work of IDEO. They have some really interesting products, looking at diabetes, looking at breast pumps, looking at artificial intelligence, I first came across Gyles, when we were working on a piece together, he ultimately published this in the European Journal of Emergency Medicine in 2021. He talked about an app for the treatment, the Health Design, and patient centered treatment of sickle cell patients in the emergency department. So before the episode get started, we actually were talking a bit about design. And each of them were sharing when they first realized they were thinking like a design or how they implement design in their daily lives. And in both of their cases, they talked about taking care of patients in their clinical environments. Delfina actually added that she realizes in having two young children, she actually is designing on a daily basis. Okay, let's get to the conversation. What strikes me from what both of you have shared is because I know from working in healthcare is there's a lot of resistance. There's a lot embedded in tradition. Too many times we hear well, this is the way we've always done things. So I am sure that you are used to not just the resistance of human nature and people, but specifically the resistances within healthcare. So I'm wondering if you can share for audience members that really trying to wrap their head around this concept of design, where perhaps there's been a resistance, maybe from a patient, maybe from the healthcare team, maybe from the institution, maybe from the built environment, and how you worked through that resistance. Delphine? Delphine Huang  04:03Yeah, I mean, I think, you know, like whoever you're working with, whether it's a client or a patient, at the end of the gate, the two are also human. Right. So I think there is a, you know, when we talk about design, we talk about being empathetic, putting ourselves into their shoes. And so when you hit these moments of resistance, it's actually taking a time to slow down and actually understand, like, what is driving that? That thought process for that individual. And so, you know, a lot of love and work, I would say in design, there is the actual thing that you're trying to build or design for app or medical device, but it's also about aligning your lining, what could be multiple stakeholders also that are involved in this and so, you know, I think when you have this moment where it feels more I would maybe she A different resistance to feeling, maybe a moment of tension is to actually take a moment to be like, Okay, how can we better understand this moment tension, because within that, you might actually find the path of clarity that you need in order to then move something forward to design something forward. So an example of this would be like, you know, when we're talking to hospital administration, a lot of them are indoctrinated, or come from the theory of like, you know, LEAN improvements, or Sigma Six. And there are a lot of parallels actually, with that with design, I actually think they actually complement each other really well. And so it's about thinking about like, actually, how do you then speak their language? How do you bring in moments that there they are accustomed to and integrating that in order to be like, well, actually, and how do we elevate them through those means the principles of design, great, Resa Lewiss  05:56Gyles, what came to mind? Gyles Morrison  05:58So this is really advice, I would offer not just in healthcare as a way to overcome that resistance. But anytime you're facing resistance from people, I'm not a parent yet, but I've been around a lot of young children, or someone who, for whatever reason is against you. And I think it's that whole advice, the general advice that you would get from David Carnegie's How to Win Friends and Influence People comes to mind. And the first big take home for that is to genuinely be interested in other people, which is something we can take for granted when we're talking about friends and family. But when you genuinely care about someone else's interests, it means that you start trying to read between the lines, and whenever there's doubt to ask explicitly, but over time, because you've built a relationship with that person, you instinctively start doing what's right for them, like my wife doesn't have to ask for peppermint tea in the morning, I just notice what she's gonna want, not just from tradition, but I can sense this is probably what she's gonna want right about now. And I think this can be applied very quickly, even when you are dealing with a stranger. Just having that first genuine interest in seeing how you can help that person, which then should motivate you should guide you to be asking the right questions and observing as well, because especially in design, a lot of what we determine the requirements or satisfy a user's needs, doesn't come from what the user tells us, it can often come from what the user shows us, or better still, what we learn from what the user isn't doing or what they can't do. So it's having that inquiring mind, which still first comes from genuine care about this person's interests. So I found that always worked really, really well in healthcare, I think as well, as a doctor dealing with clinical UX and design and is genuine working in digital health. Being a clinician myself is kind of like a superpower, you kind of get a power up, where when you are speaking to fellow clinicians, and you make it very clear from the outset, you're part of the solution to their problem that you're here to help. And you understand generally, even if you've never worked with them in their department, even in their country, generally, because your clinician like them, that they can trust you and that you're going to understand them because you've got a shared language, shared experiences. And so actually, the easiest conversations I've had in digital health, and clinical UX has always been with fellow doctors, more so than anybody else, followed by all other allied health care professionals, and actually is most difficult at times working with non clinicians, who have a very strong opinion about how things should be done. So again, I have to genuinely care for their interests. Is it money that's motivating them? Is it success of the project that's motivating them? And then see, how does that tie back to what I have to do in my job? What is it linked back to my agenda, and then have that common ground and make sure both of us are happy state communicating about our needs, and then that normally leads to success, it breaks down the wall that people can have, or resistance and build that bridge to connect to so that you can walk across and get stuff done? Resa Lewiss  09:28Thanks, I really like that reframe, rather than resistance perhaps consider it tension, which can be both positive and it does not necessarily have to connote negative. So in the show notes, the audience will be able to read about your respective work your project, Delphi, and I spent quite a bit of time going through your website reading about your projects. And, you know, most interestingly is your role when you're not an emergency physician at SF general is you are a medical director for IDEO some Audience members may not know about audio. And so I'm wondering if you can share a bit about the company, your role. And can you can you let us know what are you working on right now? Yeah, Delphine Huang  10:11Sure. So IDEO is a global design consultancy firm. And we are most like when most people think of IDEO, they think of, you know, products such as Oxo or Apple, I was involved in designing the first Apple mouse, for example. But over the years, besides doing physical products, we also have expanded our services and do a majority of our work in digital experience. And also think about new ventures or new opportunities. So, a lot of times organizations come to us because they have some big question that they're trying to solve. And they're looking for a creative or innovative way to be able to do that. And so, you know, IDEO is a multidisciplinary organization where we were, I think, where our strengths lie, is that we have folks that are spanning from interaction designers, to design researchers, to business designers, to someone like me, who's a clinician, to data scientist engineers, and we believe actually, the collective mind is a lot stronger than the individual mind. And so I think, with that, you know, we are a lot of times given a challenge, and from there, able to explore new avenues that perhaps haven't been thought of yet. In terms of my role, so I am one of the medical directors in our health domain. And my role primarily is to bring in the, the, the perspective of the healthcare ecosystem, and provide that lens of perhaps the different stakeholders that might be a play and the different levers that might be in play when trying to design. And so sometimes I think I think of myself a bit of like, I'm the gut check, of, you know, we can dream all these different different solutions out there. But you know, at the same time, we also have to think about the pragmatism of it, as well, as you know, what is our current state of, you know, our healthcare system. So there's a little bit of my role in terms of projects, and current, I most recently finished a project related to home care services. And I think that this was a you know, in COVID times, you know, this is an area ripe for innovation, you know, we're seeing a lot of movement, healthcare, thinking about what the outside of hospital experience could be like. And especially at home, in our current pandemic. So, you know, I think that, you know, the that this is an area that could be the has a lot of opportunities, because it's actually a lot of patients and families that need, you know, about, I think it's like 70% of patients who use home services or Medicaid beneficiaries. And we actually do see a lot of racial disparities, elder disparities when it comes to outcome and quality of care. So given the one on one nature of home care, I think there are opportunities, one of the things that we explored was, you know, I think they, the key to there a few things that we learned along the way was one, how do we like design and integrate tools, not just for the patient, but actually for the care provider? And what are those opportunities of community interacting patients, even when that provider is not with the patient? So you can build that trust and psychological safety? And second, thinking about how can we design delightful and interactive moments for patients who have a long road of recovery? And so thinking about what is that moments of being able to share progress and build positive feedback so that people are engaged in taking care of their health? So I think, you know, these are some of the projects that we work on. And this is just an example, where design I think, has a lot of can have a lot of tools that can help individuals think through how we can improve a particular situation health. Resa Lewiss  14:11Yeah, Gyles I want to get to you about your current work, but I want to first dovetail off Delphine something you shared about access, equity, health disparities, and sort of trying to raise the level of standard that everybody is getting the same care and particularly Health Design, I think is having its moment because of COVID because of and we can talk about the US and Gyles welcome your examples from the UK and Germany. You know, it basically pulled a scab off of the racial inequities, the racism throughout healthcare, in terms of patients and even in terms of health care trainees, but for you know, for the sake of argument here, we're talking about patients the despair The racial ethnic disparities and the racism. So in, as I said, health design, I think is having its moment. And I would wonder, with your role with IDEO, how have you seen that manifest? Are you just bananas, busy with many, many projects, and many, many consultations, you know, what's been coming your way because of the pandemic? Delphine Huang 15:22Yeah, I mean, I think when it comes to thinking about equity and thinking about health equity, specifically, IDEO, along with many other organizations that we're actually seeing now are grappling with, how do we how do we, as an organization, as a health care system in the US address, some of the some of the disparities that have really been they're always there, but now really exacerbated and highlighted. And during COVID, and in some ways, there's an awareness that we there, where's not even that imperative that we address these issues. And so I think that design itself really has a role to play in that kind of all the things that we've kind of talked about, of why design is a good can be helpful in these scenarios is that, you know, thinking about how we can in a moment where, you know, COVID has really highlighted these gaps in health care, it also has been an opportunity to really bring out Creative Innovations about how health care can be delivered and to whom we're really delivering it. So I think there are these moments where I think thinking about how both the merging of technology, human centered design, and healthcare come together, are at play right now. And I think we're seeing that across all organ, a lot of organizations out there and how they're approaching their work. There's a piece of organizations being wanting to be introspective about their own journey when it comes to equity at this point, Resa Lewiss  16:53Gyles, feel free to jump on that and update us on what you're working on right now. Yes, so Gyles Morrison 16:59I primarily focus on either working independently as a clinical UX strategist. So I primarily work on products in the digital therapeutic space. So any evidence base digital tool that can prevent, manage or treat disease, this can be disease anywhere in the world, on any disease, really. But what I love about that work is that you're suddenly moving the power more towards the individual patient to take more control over their health, because they're in a position to record their data most of the time and digital therapeutics and get feedback on their health in real time, within a forms them of what sort of options that they have to improve their health, or even reassure them if they had any previous concerns, which then feeds into any new treatment plans or seeing their primary care physician, so on and so forth. And what I love about this is that a lot of the issues that we face with health inequalities can be easily overcome through the more encouraged use, encouraged development and use of digital therapeutics. So you know, depending on the statistics that you look at, it can be argued that actually, people are more likely to have access to a mobile phone, then immediate healthcare services. You know, even if it's the back in the day, Nokia 9210, with the snake game that people might remember from the 90s, even those devices still can provide a very sophisticated offering to you. So the example I like to give is M-Pesa which is commonly used across Africa, particularly East Africa, which is a completely digital service to manage your money. So you can access your bank account, just through USSD, which is similar to SMS, but it's that hash, hash key and then few digit stuff that you do in your phone, which then gives you access to your ability to not only draw money as cash from an appropriate store, but for you to even send money to other people. Let's think if that instead of having financial data had medical data, you can give even homeless people the ability to own their own health data when they have a mobile phone because many homeless people, even in very deprived parts of the world have a mobile phone. And this is one of the reasons why I love working in digital therapeutics. As I said before, it can bring that shift of power more towards an individual. So anybody who needs healthcare services at some point is going to have to interact with a professional pharmacist or doctor so on and so forth. But there's many medical problems that we have or medical questions that we have, which can be easily solved on someone's own like we've seen this We've encouraged people to, you know, Google stuff, which isn't always so useful because it doesn't take into full consideration the realities of someone's lived experience and their personal health needs. But people are trying to help themselves. But we don't really have a sophisticated suite of tools and technologies to really allow people to do this properly. So that's why I like focusing on the digital therapeutics, because when we do that, right, we will be able to serve underserved people much more with language barriers. Even confidence with using technology to improve their health, we started to empower these populations. And when we satisfy their needs, everybody else who can take modern technology for granted, their needs are satisfied as well. Resa Lewiss  20:52Do you want to tell the audience briefly about your online course your clinical UX course? Yes. So Gyles Morrison 20:57the clinical UX course, he goes into his second year in January of 2022. So the course is designed to help anybody whether they are new to UX, or experienced in UX, perhaps they've done a recent bootcamp in UX design, or they've even been in UX for 10 years or more, to gain that additional skills, knowledge and experience on working in clinical UX. So how can you change your profession and go into this field, or have it as another string to your bow, so we had nine students graduate this year in 2021. And this is students all over the world, doctors, paramedic psychologists, UX professionals, new and old. And they've loved it. I'm biased, because I taught them. But the feedback has been very, very positive. And students have been able to even get jobs whilst taking the course, because the whole course is taught part time. So it's specifically designed to help people who's in full time education or full time employment, to spend a couple of hours a week on the course, if they're already in digital health or healthcare in general, they can base their coursework on what they do in the day job, or they spend a couple more hours Additionally, in the week, if they're outside of healthcare currently. But it's really to provide people with that experience, and a group of like-minded people globally, who are really passionate about making a difference in health care, food design. Resa Lewiss  22:32Great. I want to give each of you the opportunity to ask each other questions. Delphone, you want to start? Delphine Huang  22:39Sure, I would love to hear more about you teaching about clinical UX. Actually, I'm curious if you know, whether whether things are moments where you see learners or that are taking on this endeavor of clinical UX. moments for them to what are the moments where it's like an aha moment for them? Yeah, yeah. Gyles Morrison 23:08So the most common aha moment, regardless of someone being a clinician or not, is when it's revealed to them the crazy similarities between diagnosing patients and working as a designer, the whole process of there is a problem. So you investigate it. And through your investigations, you might start having ideas of what the solution could be your treatment plan. And so you give it to treatment, but then you still do a check to see you know, you know, an evaluation, further blood test, whatever the investigation that is required, and even still be saved in his life. So here's the treatment, we expect you to get better, but it'd be any problems, come back and see me the same thing you should be doing in design, someone comes with a brief, you gather as much information as possible. And you go through that cycle of understanding the problem, as well as possible, narrowing down to the right problems to solve, exploring potential solutions, testing out improving, and then making sure that if, after someone's been given a solution, they need to make any changes, they can come back to you. And so when conditions in particular, doctors realize that they're like, Wow, I get this, and I care about this. It's, it's not so hard to do is like as much as I need to learn new skills. It's that mindset change that people fit they need to go through as clinicians, we say don't they don't need to change the mindset. The only thing about the mindset that needs to change is to realize that you won't just be now using your medical degree and experiences, there's going to be some additional knowledge you're going to have to have, but otherwise you're in a good place to solve problems in healthcare as a design if you come from a clinical background. And then when the non designers I'm sorry, the designers realize this when the UX to start understanding this as well. They like I now see how Ready got such a common ground with clinicians, I can see how I can start a conversation with them and get them on my side because we've got this shared experience, even if it's seems to be different industries and different problems that's been solved. So that's perhaps the best aha moment that I see. amongst the students. The other one is when they realize how much they can earn, when they stay. That's another one that what okay, I definitely, I really like this whole clinical UX thing. Let's let's go for it, then. Yeah. Resa Lewiss  25:34Gyles, what do you want to ask? Delphine? Gyles Morrison 25:37Um, I'm really keen to know, what advice would you offer your younger self? Because I'm assuming that you weren't involved with design, before medical school? And if you didn't know about design, then would that have changed your your path in life? Delphine Huang 26:03Um, good question. Um, I don't think it would necessarily have changed the path, per se, I think that, at the heart of it, I'm still physician, and I still love the art of medicine. I think that, though, when I, you know, when I think back to folks have come to me and be like, you know, how do I get started on a journey similar to yours, I would say that, that, you know, the path at the end of the day is not clear. Because in medicine, you always have, you kind of have this trajectory that you go on, you go through medical school, and then go to residency become attending. And that path is very clear. But when I think for all of us out here on the call is that is that you have to forge your own path at the end of the day, but that you should take the opportunities as they come because you never know where it will lead you. And it's whether or not it's, you know, helping with a startup just help sit through their UX experience, and you're doing it as maybe something you do as a med student, or going to conferences and meeting different people in the industry, you start hearing some of their pain points, and what they may be struggling with, because a lot of those folks don't have experience in health care, and don't even have a weight of the lens to be able to get it. And so that can be you, right. And so I always tell folks, you know, use the opportunities as you especially as you're going through training, to one learn about the pain points of the industry, but then also learn the pain points of your hospital. Prior to coming out of prior to coming to IDEO. And prior, I had done a fellowship at Stanford called Biodesign. I had never thought about you have this physical product, let's say, let's say a ventilation machine. And then I never thought about who makes that machine? What goes into the design of it. What is components that need to be in there? What is the supply chain from being built in a manufacturer all the way with regulation, with the delivery to and training of an individual to use it, each of those steps, as someone who's early in it, who's working at the hospital had the opportunity to learn and that knowledge is so useful to somebody else in the industry? So I would say that those are the those are the things I would tell folks as they're thinking about either whether it's you know, doing something part time or making the jump fully into industry, that if you're a clinician, you can you can learn those moments and bring that knowledge to others. Resa Lewiss  28:59I know I say this every week, what a great conversation. But seriously, what a great conversation. I think it's obvious to you audience how much Delphine Gyles and I love speaking with each other and love the topic of health design and user experience. Delphine shared that this may have been one of her first podcast recordings, and I'm so glad and feel so lucky to be able to amplify her amplify her leadership as a health designer, and amplify her work. As an ideal Medical Director. Gyles and Delphine are people to watch in the health design and user experience space. You audience have a role in health design, you are designers. Think about your health. Think about health care. Think about health care that can better serve society. See you next week. The visible Voices Podcast amplifies voices both known and unknown, discussing topics of healthcare equity and current trends. If you enjoyed this episode, please rate and review us on Apple podcasts. It helps other people find the show. You can listen on whatever platform you subscribe to podcasts. Our team includes Stacy Gatlin and Dr. Giuliano deport you. If you're interested in sponsoring an episode, please contact me resa@visiblevoicespodcast.com. I'm based in Philadelphia, Pennsylvania, and I'm on Twitter @ResaELewiss. Thank you so much for listening and as always, to be continued

Macalester College President Suzanne M Rivera

Dr. Suzanne Rivera is the President of Macalester College. She also is a Professor of Public Affairs, and her scholarship focuses on research ethics and science policy. Rivera has written numerous journal articles and book chapters, and she co-edited the book Specimen Science. Her research has been supported by the NIH, the NSF, the DHHS Office of Research Integrity, and the Cleveland Foundation. She is engaged in numerous civic and municipal leadership roles, including Chair of the Board of Public Responsibility in Medicine and Research (PRIM&R), Appointed Member of the Executive Council for Minnesota’s Young Women’s Initiative, Board Member of the Science Museum of Minnesota, Board Member of College Possible, and Member of the TeenSHARP National Advisory Board. Rivera received a BA in American Civilization from Brown University, an MSW from UC-Berkeley, and a PhD in public policy from UT Dallas.Head Start ProgramsBrown University Undocumented, First-Generation College, and Low-Income Student Center TranscriptSUMMARY KEYWORDSstudents, people, brown, feeling, college, Headstart, Minnesota, Posse, support, low income students, financial aid, St. Paul, sponsored, day, job, brown university, group, Marian Wright Edelman, graduate, phdSPEAKERSResa Lewiss, Sue RiveraResa Lewiss  00:36Hi, listeners. Thanks so much for joining me with today's episode and I'm gonna start with a quote. You can't be what you can't see. One more time, you can't be what you can't see. Now this was said by Marian Wright Edelman. She was the founder of the Children's Defense Fund and was one of the original founders of the Headstart program. She graduated Spelman College and Yale School of Law. Now Marian Wright Edelman is not my guest in today's conversation, however, she was an inspiration for my guest. Today I'm in conversation with Suzanne M. Rivera, PhD MSW. Sue. Dr. Suzanne Rivera is the president of Macalester College in Minneapolis. She's also a Professor of Public Affairs. Her scholarship focuses on research ethics and science policy. She received her BA in American civilization from Brown University, a master's in social work from UC Berkeley, and a PhD in public policy from UT Dallas. Now Sue and I have a few areas of overlap. Number one, we graduated college one year apart. Number two is the Headstart program. Growing up in my small town, Westerly, Rhode Island, I was exposed to the Headstart program through my mother. My mother is an elementary school educator, and she did preschool testing for children. And my knowledge at the time was she helped with evaluating children for learning disabilities, for challenges with speech, sound, and sight. Let's get to the conversation where when we get started, Sue is explaining her ideas about mentorship, and who her mentors were, or at least a few of them. Sue Rivera  02:47I mean, one thing I tell young people all the time is, don't hold your breath waiting for a mentor who shares all of your attributes who can inspire you because especially if you're from a historically excluded or underserved group, the likelihood that there's going to be some inspirational leader who shares all your attributes is pretty small. So the mentors and sponsors who've made the biggest impact in my life have all been men. They've all been white men, they've all been white men who were significantly older than me and much more accomplished, and who came from backgrounds that were, you know, that had a lot more privileged than my own. And yet, we were able to connect on a deep level and they really opened doors for me. So a couple exams for Harry Spector at UC Berkeley was a great mentor is no longer with us. Another great mentor, for me was a guy named Al Gilman, a Nobel Laureate, who, who I worked for at UT Southwestern in Dallas, Texas, opened a lot of doors for me, encouraged me to go back and get my PhD when I was a 35 year old mother of two school aged kids. And once I got it, promoted me and then what, and then once I had a faculty appointment, invited me to co author a chapter for him with him in the kind of most important pharmacology textbook, that he was responsible for publishing, which means My name is forever linked with his in the literature, which is an incredibly generous gift for him to give to me. People like that have sort of stepped in at at moments where, if not for them, I might not have seen in my self potential that was there. Another person I would mention is a professor from my undergraduate days. Greg Elliot at Brown University in the sociology department, who sort of encouraged me to think about my own interests in social inequality and poverty as things that were worth studying things that were worth studying in a rigorous way as a scholar and not just sort of feeling badly about or complaining about or having a personal interest, but really taking them on as an intellectual project. So he sponsored me for a summer research assistantship, he had me serve as a TA in one of his classes. And he sponsored a group independent study project for me and a bunch of other students. And I'm still in touch with him to this day. He's somebody who certainly helped me think about myself as a scholar at a time where I was really thinking, I was just barely holding on, like, hoping I could graduate with a BA, I wasn't imagining that I could go on to become a professor and eventually a college president. Resa Lewiss  05:36People saw in you what maybe you hadn't yet seen for yourself. I was a sociology concentrator, and I took Professor Elliott's class, and I remember him reading from Kurt Vonnegut Mother Night, and it was really moving, he sort of cut to the punch line of we are who we pretend to be, so we must be very careful who we pretend to be. And that stuck with me. And that also launched a whole lollapalooza of reading Kurt Vonnegut. Sue Rivera  06:07Yeah, actually, this is one of the beautiful things about a liberal arts education, I think is that you know, so you became a physician after being a sociology undergraduate concentrator. I dabbled in a lot of different things as an undergrad did not imagine I would eventually become an academic, but I feel like the tools I got, from that degree have served me really well, moving between jobs. You know, I originally went to go work for the federal government thinking I was going to do policy work. Eventually, I worked in higher education administration, then I went back and got a PhD in public policy. But, you know, all along as I was making career changes, the tools I got as an undergraduate to think critically and communicate effectively and, you know, think in an interdisciplinary way work with people who have really different perspectives than I have. All of that is just priceless. I mean, so so incredibly valuable. Resa Lewiss  07:02Speaking of liberal arts education, let's jump right in and talk about Macalester for audience members that aren't familiar with the college. Tell us about the college and tell us about how it's been to be President. Sue Rivera  07:14Well, it's a wonderful college. It's it's almost 150 years old, and it's a originally was founded by Presbyterians and although still Presbyterian affiliated his is a secular liberal arts college, a small private liberal arts college in St. Paul, Minnesota. It has a deep history of being committed to social justice. It was the first college in the United States to fly the United Nations flag, which is still flying outside my window in my office here. And in fact, Kofi Annan was a graduate of Macalester the four pillars of a Macalester education as they're currently described, our academic excellence, internationalism, multiculturalism and service to society. And I think the character of this place actually is not that dissimilar from the brown that you and I know, in the sense that social justice is really important part of the character read institution, but it also attracts people who dispositional li are attracted to activism, to wanting to make a more just and peaceful world who think about their education in a sense as not only a privilege, but also an obligation to go out and make things better. And so the students we attract at Macalester are really sparky, in the sense that they, they, they're, you know, they're really passionate. They all come with it, let's just set aside that they're really academically talented because they all are so that no longer is a distinguishing characteristic once they get here because they're all academically talented. So what distinguishes them when they get here is all the other stuff in addition to being bright, you know, they're, they're committed athlete, they're a poet. They're a weaver. They're a dancer, they're, they're an aspiring politician involved in political campaigns mean that they're all just how they're debater, you know. So whenever I meet students, one of the first things I say to them is, well, what are you really loving right now? Or, you know, what's keeping you really busy right now, instead of saying, you know, what are you taking? Or what's your major, I'm much less interested in what their major is. And I'm much more interested in like, you know, what's got them really jazzed? What are they spending their time on? What's what's so exciting that they're staying up into the middle of the night working on it, Resa Lewiss  09:40The timing of your start.  There was an overlap with the murder of Mr. George Floyd. And I'm wondering if you can share with the audience how that sort of set a tone and set an inspiration for your work. Sue Rivera  09:55Yeah, it was a really difficult time I actually accepted the job. On January 31, of 2020. So at that time, if you can remember back to the before times, none of us had ever heard of COVID. And the board of trustees who offered me the job, were saying, this is going to be a turnkey operation for you, the previous president had been here for 17 years, smooth sailing, really easy transition, you know, easy peasy. And three weeks later, you know, every college in America started closing because of COVID. And I realized, wow, this job is about to get a lot more challenging. I was in Cleveland, Ohio at the time at Case Western Reserve University. And I was sort of watching as the news was unfolding, but also doing my job at another higher ed institution. So I could anticipate how it was going to get more difficult to come to McAllister, then literally on the day that I got in my car to drive to Cleveland, to drive to St. Paul from Cleveland to take this job was the day that George Floyd was murdered. So as I was driving all day, north of Michigan, and then across the up of Michigan, going west to St. Paul, I would drive all day and then turn on the TV at night and watch the news. And as we approached St. Paul, the city was deeper and deeper in grief and righteous anger and fear National Guard troops were coming in, there were fires all over the place. In fact, I was supposed to start the job on a Monday and arrive on a Saturday and I got a call on that Saturday while I was on the road saying don't try and come into the city because we've got a curfew. And it's not feeling safe right now. Just get in a hotel outside of the city and try and come in tomorrow. So I arrived really on Sunday in St. Paul to start the job on Monday. And I and I recognize that my first day was going to be very different than what any of us had imagined. Because what the, what the moment called for was to name the pain and grief and anger everyone was feeling. And to try to address people's grief in a way that was honest about the challenges offer some comfort, but also a call to action about how we could be how we could be of help how we could be of service. So you know, the first couple things I did that week were one was I attended a silent vigil that was organized by the black clergy of St. Paul from various different faith, faith communities, I also attended a food and hygiene drive that was organized by our students, you know, it's just a lot, you know, we stood up a mutual aid fundraising drive, within the first couple of weeks, it was just a lot of attending to the immediate needs of the community. And also, all of this was complicated by having to do almost everything by zoom, you know, so, you know, Zoom is good for a lot of things. But when people are crying when people are scared when people, you know, our international students, many of them couldn't go home, because of COVID. So they were staying over the summer, it was just very, very complicated and didn't look anything like what we thought it was going to look like. And what I didn't have was a reservoir of trust built up with this community. And the only way I could talk to people was on a computer screen, which doesn't give the full benefit of body language. It doesn't give all you know, everything you learned from being in a room with somebody. The various facial expressions, the way the way that when you talk to a roomful of people, you see two people make eye contact after you've said something and you recognize you have to go follow up with them and see what that was all about. You know, none of that is possible on Zoom. And, and it was just it was just an impossible summer. It was very, very difficult. I was trying to introduce myself at a time where I also had to deliver a lot of bad news to people. You know, we were having to take all sorts of difficult decisions about keeping the residence halls densifying the residence halls by telling some people they couldn't move back in August that was disappointing for them taking decisions related to the college's finances, like suspending contributions to employees retirement accounts for six months until we could understand how we were going to do financially. arranging for testing COVID testing was incredibly expensive and something we hadn't budgeted for figuring out where to put hand sanitizer and plexiglass and what our masking policy should be. I mean, really, it was like being a full time disaster management person not being a college president. And in many ways, the whole first year was was not being a college president. It was it was just one really challenging, ethical or logistical decision after another all year long. Resa Lewiss  14:50According to my reading in 1991, you delivered your graduation class orration and I'm wondering if you can fill us in on about what you spoke Sue Rivera  15:04well, I, you know, I basically I talked about my unlikely journey to being an Ivy League graduate and what that could mean for all of us about the possibilities of you know pathbreaking of moving into uncharted territory. When I, when I went to college, we didn't have the expression first gen, and we didn't have really a sense of pride around being a financial aid student to the contrary, my experience at an elite institution was that if you were there on financial aid, and came from a low income background, that you tried to hide it as much as possible in order to fit in, you know, back then Brown had a policy of limiting financial aid students to 30% of the student population. And that meant even just students who only had loans and got no grant awards. So just imagine an environment it's not like that anymore, I should clarify, Brown is not like that anymore. But back then 70% of the student body were full pay, meaning their parents could write the whole check. And just imagine what that means when the tuition is significantly more than the, you know, median income for a family of four in this country. It means you're, you're in a really elite and I daresay elitist environment. So what that meant if you were a student on financial aid was that it was kind of a scary place, it was kind of an alienating place. And when I arrived there, I really felt like a fish out of water. I thought about transferring, had a job in the Ratty in the dining hall. You know, my work study job, where I was sort of serving other students and feeling I don't know if I would say inferior but definitely had a sense of imposter syndrome. Like you know, one of these days somebody is going to figure out I don't really belong here. And the turning point for me was that in in the spring semester of that first year for me, a chaplain, Reverend Flora Kashagian who I don't know if that's a name, you know, but she offered like a discussion group, she and Beth Zwick, who was the head of the Women's Center offered a discussion group for students struggling with money issues. So I opened the school newspaper one day, and there's an ad in there. That's like, I don't even remember what it said. But it was something like are you struggling with money issues? Are you on financial aid, you know, are things tough at home, and you don't know how to talk about it come to this discussion. And let's rap about it. And for whatever reason, that spoke to me and I, I went, and there were like, 11 or 12 people in the room for this discussion group. But it was like the Island of Misfit Toys. Do you remember that, that that Christmas cartoon where like, every toy is broken in some kind of way, but they all have their gifts, right? Every student who showed up for that thing had a different non traditional path to get to brown and we were all broken in some kind of weird way. You know, for me, I had grown up in an immigrant home on was on public assistance, food stamps, free lunch, you know, you name it. I was there on a on a Pell Grant, which are, you know, the neediest students. And there were other people in the room who came from really different environments. I grew up in New York City, but there were other people who were like, from a rural farm family, or, you know, I mean, just all everybody had different reasons for why they came to that discussion group. But it was magical because we all saw each other in a really like, pure and non judgmental way. And we could all be real with each other. As it turns out, one of the other 11 people was the person who would eventually become my spouse. And other people in the room that day are lifelong friends. I mean, we really bonded, we ended up forming a club called sofa students on financial aid. We even have little T shirts made up that said, so far, so good. And it had like a picture of a couch that was all ripped and torn on on the front. And by making it a student club, that got incorporated by the student government, we kind of created legitimacy for ourselves on campus, and started to create a way of talking about being from a low income background that didn't feel shameful, that felt prideful, not prideful, in the sense of hubris, but in the sense of like, acknowledging the distance traveled was great that we were not born on third base. And yet we were here sort of competing with people who had every advantage in the world and having a sense of deserving to be there or belonging there. So by the time I was a senior and I got selected to give the one of the two oratory addresses at graduation, the theme for me really was one of triumph of having overcome all of those hurdles and feeling like finally I feel like I deserve at this place. I earned my spot here. Resa Lewiss  19:57In my freshman unit, there was a woman with whom I'm still very, very close. She is an attorney. She's an LA county judge. And she transferred from Brown for some of the reasons that you considered transferring. And she to this day says that it's one of her biggest regrets. And also she really feels if they were more visible vocal support for first gen students than she thinks it would have made a huge difference for her. Sue Rivera  20:29Yeah, no doubt and and Brown has come a long way. In this regard. I consider them a real leader. Now they have this you fly center. It's like it's an actual center on campus for people who are undocumented first gen or low income. And they get extra support. They have a dedicated Dean, they have programming. I think it's a real testament to the seriousness with which Brown has taken the unique challenges that face low income students going to a place like that. It also helped a lot that between Vartan, Gregorian and roof Simmons, two presidents, who I greatly admire from Brown, they were able to raise the money to provide financial aid to students who need it, but also to go need blind. So I told you that at the time that I went there, they limited the number of students on financial aid to 30% of the student body, that's no longer true. Now, when you apply to brown, you are admitted without regard to ability to pay and they commit to meet full need. So I think it's a much more socio economically diverse student body today. And I think Brown has really been a leader in how to increase access and support low income students when they get there, because I think it's a two part problem. You know, just letting people in. But allowing them to sink or swim is really not helpful. You need to increase access, but then also provide the support necessary so that the that educational opportunity is a ladder to economic mobility, people have to actually be able to finish, you know, complete the degree, and then go off and have a career afterwards in order for the opportunity to really, you know, fulfill that promise. Resa Lewiss  22:16Yeah, it reminds me a bit of what you described with the Headstart program of not just, you know, supporting this one individual child, but it's actually the system in place. So similar, like it's one thing to get in, but you have to help the student, succeed, thrive. Be healthy in that environment. I believe I've read that you that you're actually doing work to increase access and admission of students that may have fewer resources in the state. Can you talk a little bit about that initiative? Sue Rivera  22:47Yeah, I'd love to. So when I arrived at Macalester again, just like a little over a year ago, Macalester already had a relationship with the quest Bridge Program, which is one way to recruit first gen and low income students. But of course, we take those from all over the country. We also had other cohort programs like the Bonner Scholars Program and the Mellon Mays program. But after the murder of George Floyd, one thing that I heard a lot from people on campus was that while Macalester had done a great job recruiting a diverse student body from not only all over the country, but also all over the world. We have a very international student body that we hadn't done as much to focus on students from right here in Minnesota, especially talented students from historically excluded groups from right here in Minnesota. So we did two things last year. One was that we established a new fund called the Minnesota Opportunity Scholarship Fund, which is an effort to raise scholarship dollars that will be targeted specifically to talented students from Minnesota. And the second thing we did was that we joined forces with the Posse Foundation to sign on as a posse school, whereby Macalester will become recipients of the first posse from the state of Minnesota. I don't know if you're that familiar with posse, but that's a program that's 30 plus years old, that that's based on the Really clever idea that that their founder Debbie Bial had, which is that if you pluck one student from an under resourced High School, and you send them across the country to a private liberal arts college, they may feel like a fish out of water. But if you cultivate a cohort of students from a city, and you give them in high school leadership training and other kinds of support, and you foster trust and friendship among them, and then you take a group or a posse, if you will, and you take those 10 students and send them all to the same liberal arts college, the chances are, that they're going to be better equipped to persist and complete because they have each other you know, they don't have that feeling of walking into the dining hall and not seeing any familiar face. We're not having anybody who knows what it's like in their home city neighborhood. You know, the same feeling I had when I walked into that room and I saw the other Misfit Toys sitting around in a circle. The posse already formed a trusting cohort that can keep each other company and offer support through the four year experience of college. So we are adding posse to our other cohort programs here on campus. But we've specified that the posses gotta come from here in Minnesota, they will come from the Twin Cities, either Minneapolis public schools or St. Paul Public Schools. And we're going to get our first group of 10 in September, and we will give them all full tuition scholarships. It's really exciting. Yeah. Resa Lewiss  25:47Wow. What a conversation and honestly, I could have kept speaking with Sue for quite a while. I think she enjoyed the conversation too, regarding my friend that I referred to in the conversation. Attorney judge Serena Murillo. As I said, we're still friends, and she knows that I had tipped her during this episode. And all I can say is, listen to your heart. Listen to your brain. Have a growth mindset and know that your professional path is not linear. Thanks for joining and see you next week. The visible Voices Podcast amplifies voices both known and unknown, discussing topics of healthcare equity and current trends. If you enjoyed this episode, please rate and review us on Apple podcasts. It helps other people find the show. You can listen on whatever platform you subscribe to podcasts. Our team includes Stacey Gitlin and Dr. Giuliano Di Portu. If you're interested in sponsoring an episode, please contact me resa@thevisiblevoicespodcast.com. I'm based in Philadelphia, Pennsylvania, and I'm on Twitter @ResaELewiss. Thank you so much for listening and as always, to be continued