S2E20: Leadership Through Diversity

Harjit: Let's see. Yeah.

Dr. Nwando: Okay.

Harjit: Perfect.

Dr. Nwando: Can you guys hear me okay?

Harjit: Yes. You sound beautiful. So I think the biggest reason we started this podcast is because we really wanted to talk about diversity in medicine. And I think that . . .

Margaux: Do you want a more formal . . .

Harjit: No, I was going to . . . this is my intro. It'll make sense. I promise. Okay, fine, maybe I'll do it a different way.

Margaux: Just a little bit of a softer intro.

Harjit: Just a softer intro, I know. Sometimes we try different things. Okay. So we have a class called Layers of Medicine at the University of Utah. That's basically a class where we can see different perspectives to medicine that aren't the "hard sciences."

And last year, one of the guests that came is someone that really connected with me. And I remember being in the lecture hall and everything she said really resonated with my heart and it was something that I cared about and something that we care about in this podcast Bundle of Hers. And so we are so excited to have you in the studio, Dr. Nwando.

Dr. Nwando: I'm so excited to be here.

Harjit: Yeah. And we also have Margaux with us today.

Margaux: Hey, I'm also super excited to be here with Dr. Nwando.

Dr. Nwando: Thanks, Margaux.

Harjit: We actually met Dr. Nwando during that class, but we had a lunch afterwards and I think the biggest thing that we all connected with was her passion for diversity in medicine. And that's kind of what I wanted to talk to you about today. Would you like to introduce yourself and kind of bigger picture, things that you are passionate about?

Dr. Nwando: Yeah. Well, first of all, thank you so much. It's such a great honor to be back here and to follow the work that you all have been doing. And I think Bundle of Hers is such a fantastic idea.

So for me, I don't even know where to begin, honestly. I'm just saying. So I'm Dr. Nwando Olayiwola. I go by Dr. Nwando. I consider myself a physician and I'm really proud of that. But I also consider myself so many other things. I'm a mom, I'm a wife, I'm a runner, I'm a gardener, and I'm also a physician that's in tech, and I do a lot of public-health-related work.

And so my career has been kind of this complex hodgepodge of different things. But all of them somehow, someway connect back to a couple of things. One is service to the underserved and people who are marginalized, another is diversity and inclusion in medicine and healthcare more broadly, and a third one is social justice.

Harjit: That's so perfectly said because those were all the three things that we all care about a lot, all of the Bundle of Hers, I think we are advocating for that. We're having discussions on that. So I think with that, I want to ask you my first question. It may sound like a vague question, but it's one I ask myself all the time. What does diversity in medicine mean to you?

Dr. Nwando: Yeah, great question. And I think it's an important question. It's good to level set because when you're in various conversations, people have very different ideas of what that means. So to me, what it means is that we have different voices, perspectives, experiences, and backgrounds kind of represented at all stages of what we do.

So a really good example of what the opposite of that is, is when I was in medical school years ago, in our dermatology lecture, most of the things that we saw and the diagnoses that we saw never had people of color. And so I'd say, "Huh, so if a person with a darker skin were to have this, what would that look like?" And I remember, you know, our attendant saying, "Not really sure. It'd probably look the same, but not sure." And really recognizing that, "Wow, even to be a good doctor, I'm going to be able to be . . . I'm not equipped if I don't have diverse representation of what I might actually see in my patients." And so I think that when you have the absence of a range of experiences, thoughts, lived experiences, then you have a lot of challenges.

Focusing on kind of how do you create an environment where you have not just representation but inclusion, and that's why you'll hear me say diversity and inclusion. Because a lot of times, and I know you all know this, you can have a range of voices, and experiences, and ideas, and perspectives, but you don't give them the space to actually declare themselves or speak out. And then you still don't have a good environment, a good safe environment.

Harjit: And I think that you hit the nail on the head with that, because we actually did an episode about tokenism versus inclusion and I think that the word "diversity" is thrown around a lot.

Dr. Nwando: Yeah.

Harjit: And that's why I think I really wanted to know what your definition of it was. Because I think a lot of times when we use that word, there's a lot of history to it. And I think the way you explained it kind of encapsulates the way that I also feel about diversity. It's experiences. It's bringing ideas to the table that are missing because in the end we're going to take care of everybody.

Margaux: I agree with Harjit. The way you defined diversity is exactly what we value and embody here at Bundle of Hers, and myself too, just having colleagues that have a breadth of experience that I can learn from as well. I have had several attendings that I've learned so much from just in one little interaction that I found so powerful. And so I think here in Utah we don't have a lot of diverse backgrounds and experiences, but it's something that I think needs to be more valued in medicine for sure.

Dr. Nwando: Absolutely.

Margaux: And one of a kind of barriers that we've been talking about in Bundle of Hers to kind of increasing inclusion in medicine is leadership. And not just in medicine but diversity in leadership across the board. And so I know that you have held several executive level positions, including being a chief transformation officer for the startup that you created called RubiconMD. And then also you were a chief medical officer for the Community Health Center, Inc. in Connecticut.

And so I wanted to ask you what kind of pathways or what advice do you have for students and our pre-medical students who are in the audience listening how they can overcome those barriers to becoming leaders in medicine?

Dr. Nwando: So I'll take a step back. So I kind of have always been somehow a leader. And I think that leadership is different depending on who you are and people have different ways of expressing leadership. So I kind of generally believe that, innately, everybody has leadership in them and it's just a matter of . . . they may not be on stages and directors and have executive titles, but they still have a way to kind of lead.

So for me, I knew very early on that I was kind of meant to be a leader. So when I was an undergraduate, I started . . . Ohio State University is where I went and they didn't have a single group that was dedicated to pre-med or pre-health for minority students. And they had a lot of other ones and I kept feeling I was going to these meetings and kept feeling kind of lost, like I just don't . . . I don't remember exactly how it happened, but I was like, "Well, I'll just form one. What does it take to form a student organization at the university?" and made it a pre-health society. And it was such a great way for me to see, "Okay, if you don't necessarily see the path, then you can kind of just create it."

And since then, you know, I've just had a number of different experiences like that. The Connecticut one was a great opportunity. I was in that organization for a few years before I became the chief medical officer. So I was there for three years before becoming chief medical officer and five years as chief medical officer. I was the first woman to ever have that position in its 40-year history. I was the first person of color and I was the youngest person that they had.

Margaux: Wow.

Harjit: That's amazing.

Dr. Nwando: So when I was throwing my name in the hat, you know, for the job, I mean, I felt like, "They're doing this national search. There's not really a lot of chance." And I remember going through the process and all the different interviews and things that I had, and at every stage it started to look like, "This might actually happen." They seemed to really like what I'm saying and what my vision is.

And so what I will say about that is knowing that all those things were stacked up against me just kind of made me hungrier. Because I was like, "If there's never a woman that does this, how will any woman ever do it?" And so I felt like, in a way, the weight of the world was kind of on me to be able to make this happen.

And so, when I got into the role . . . I think the easier part was actually, you know, convincing myself that I should apply and go for it and that I was kind of ready. The harder part was when I got it. Because a lot of the people that had been there were people that had been in the organization for 20 years, 30 years, 5 years, who were more experienced physicians, who had had a lot more experience in other things. But I had to kind of prove to them that I was the right choice and I was kind of made to lead them. And if you're thrown into a fire like that, you kind of just have no choice but to deliver.

Margaux: Yeah.

Dr. Nwando: Especially when you think about all you represent, right?

Harjit: Right.

Dr. Nwando: Yeah, you just step up. Opportunities present themselves sometimes and you've just got to step up.

Margaux: The fact that there was resistance actually made you push into it more.

Dr. Nwando: Yes.

Margaux: Because I think that's what we have done with Bundle of Hers. There wasn't a platform and there wasn't a way for us to share our stories. And that's kind of the advice we give the up and coming medical students when they ask, "What's the opportunity for this and that in medical school?" And it's like, "Well, if it isn't there, you can make it."

Dr. Nwando: You can make it. Yeah, it's so great.

Harjit: I think that's so important. I'm going to try my best to articulate this question. How have you stayed authentic to yourself and the things you care about when you're leading in a system that, from its inception, has maybe not the same values that you feel but you feel like you need to change . . . not change them but make them more inclusive? So how do you stay authentic to yourself and kind of not fall into the game that everyone's playing?

Dr. Nwando: Yeah.

Interviewer: Does that question make sense?

Dr. Nwando: That's a great question. And I'm sitting here thinking, "Wow, how do I answer this one?" Do we have enough time for this answer?

Harjit: I know. This one is something I'm always thinking about because me and my friends are always like, "Okay, we need to change things," but it's like we need to play in the system to get to the position and then do the change.

Margaux: Play by the rules so you can break the rules, but you're losing yourself.

Dr. Nwando: Maybe the kind of famous Audre Lorde quote about, you know, you can't dismantle the master's house with the master's tools. For women in particular, you know, you just bring such a different perspective to so many things. I don't think I could ever survive and I could have ever achieved what I have if I wasn't authentic.

It's kind of like telling a lie, and then a lie begets another lie and then it begets another lie. Before you know it, you don't remember the first lie and then you're kind of trying to figure out how to get back to that lie. And if you were just straightforward, you'd remember.

And I've had a hard time being someone that I'm not. And you've got to take me as I am. And if you don't want what that means, you know, I don't know what to do. Maybe I'm not the right fit. And that's an important place to get to professionally.

I remember earlier on, for example, when I first became a mom. There was a lot of pressure on me around kind of being a mother and being a senior executive in the company. But, you know, I was a new mom and then I had my second child. So I had two children, they were young, and I remember just having a lot of conflict around that with my boss, like, "You can be here," and I'm like, "No, I can't. I have babies." And I just remember going back and forth.

I learned a lot in that, because I feel like a lot of what I did in that conflict was just try to act like I wasn't a mom. Maybe I can just, you know, not do certain things or I can just go to these things that are absolutely ridiculous for me to be able to attend and really stretching my whole family. I got a nanny and all this stuff to be able to show that I'm [inaudible 00:11:28].

So when I had an opportunity to do something different career-wise, I was like, "I'm never going to do that again." It felt so awful trying to, like, bury part of who I was. And I was like, "This is who I am."

I read Michelle Obama's book "Becoming." She talked about how when she went to her interview, she took her baby and put the baby on the table, like, "Yeah, this is our interview." And it was like, "I need you to know that that's who I am." And if that doesn't work, then it's . . . and so, really since that experience, I've just felt like every part of me is important.

The second part of the question is really about how do you play the game that's being played constantly around you. So I'm going to give you a really interesting and funny story, which I'm not sure if I'm allowed to share, but I think I can.

Margaux: Go ahead.

Dr. Nwando: This is all friends. So I had the chance to be part of like an advancement promotions committee, and it felt kind of tokenized, you know, to be asked to be on it. I knew that there was a reason why I was asked in particular, but I did it. And in the process, I'd started to see how challenging it is for women and faculty of color to move up because of the way the process itself worked.

What I did a lot was play almost the ignorance card. "Hey, you know, I just want to understand when that woman was being considered, we did not think . . . we thought all these things mattered and they impacted her ability to move forward. But when we were talking about this other person, we didn't think those things were necessarily important and some of his other work was important. Why is that?" I had to really push them to . . .

Harjit: Think.

Dr. Nwando: . . . answer those questions. Yeah, to think about it. And so, that's a strategy that I've used a lot, which is like, "Help me understand your bias."

Harjit: I actually love that you say that because I think that's a strategy that I'm trying too, because I'm always like, "Wait, what did you mean by that? Can you explain that to me?"

Dr. Nwando: Can you explain? Yeah.

Harjit: Because I think a lot of times, people just say things, right? And sometimes it's even that they didn't think about it. Just that question at least makes them think about it. It's not that they inherently were on purpose ignoring it. I mean, sometimes they were, but sometimes they just don't even think about.

Dr. Nwando: They don't think about it. It's true, yeah.

Margaux: And it's non-confrontational, so there's not emotion into it, I guess.

Harjit: And it puts, I think, the thought process on the person rather than pointing a finger on them or something.

Dr. Nwando: Yes, exactly. And then the other thing is just build allies, because you can't really do a lot by yourself. Some of the ally relationships that I've built have been kind of the strange unlikely bedfellows. I'm in these meetings, I'm in these committees, and I'm like, "This seem like the right person for me to just build a relationship with." And start to say, "You know, I can't always be the one in the meetings that says, 'We need more women. We need more people of color.' I can't always be the person. It'd be great if you said it one of these days."

Harjit: Yeah, I love that response. And I think that when you say be authentic to yourself, that's something we really connect with because we believe that if people just learn who they are . . . everyone's a natural leader and they'll lead for things they are passionate about.

Dr. Nwando: Yes. And they'll lead with their strengths. I mean, there's no value of having me if I'm not representing the experience of an immigrant person with, you know, a complicated social past and all the ranges of things that make me. If I don't bring that person, then you don't want the other person. I mean, who's the other person? I won't be fun.

Margaux: Trying to fit into a box that you're . . . or not even a box, but building strengths that aren't innate to you is not easy . . .

Dr. Nwando: Yeah, exactly.

Margaux: . . . when you have great strengths within you. And I have a question building off of authenticity and identity. Earlier, you told us that you go by your middle name Dr. Nwando. And so I have noticed that many people in medicine usually go by different names than their own. And for me, recently having gotten married and trying on my partner's last name, it didn't feel like my identity. So I chose not to take that name.

So I want to ask you how you kind of navigated that decision and if it is your identity, maybe it is now, and how that sort of process came to be, or if you feel by using your last name, patients maybe stumble over that. Can you talk about that?

Dr. Nwando: Yeah, that's a really good question. So I wrote a book, which is basically like a biography book that I published this past summer, called "Papaya Head." In that book, I actually talk about the journey to my middle name.

So my first name is Jacqueline, and literally my parents chose that name because of Jackie Kennedy, or Kennedy Onassis. There were four siblings in my family. The first three of us all had an English name and a Nigerian name. And then by our last brother, by then, my parents were like, "We don't need to . . ." because they thought the world would be easier if we had those, and my last brother doesn't have an English name because they got wiser and were more comfortable with that.

And so I was always called my middle name at home, but my first name was the name that's on everything. In these two existences, I'd be Jacqueline in one place, like at school mostly, and then Nwando at home.

It's one of the things you don't realize the power of a name once it's stuck to you because it's very, very hard to change people's mind about your name. I'd be like, "Okay, in third grade, now I'm going to tell them that's what I want . . .I don't want to be called . . ." and I just kept on trying and I couldn't. Everywhere I'd go, they'd be like, "Oh, yeah, but it's just so much easier to call you Jacqueline." So that was kind of that struggle.

And so, finally, I had to finish medical school and leave the state to go to residency. And when I was starting a new state, I was like, "I go by Nwando." And that's how I kind of claimed it back.

But for my last name . . . and this is a struggle that a lot of women I know have. I know I have a lot of friends who are physicians who did not take their married names when they got married. And so my case, my last name, my maiden name was [inaudible 00:17:03], and I was heavily thinking about hyphenating it.

Margaux: Wow.

Dr. Nwando: Because I didn't want to give up my last name I had. There's so much attached to it. In Nigeria, people identify you and where you're from based on that. And, you know, it's just . . .

Margaux: There's a lot of identity.

Dr. Nwando: Yeah, there's a lot of identity that's attached to it. And so I didn't necessarily want to give it up at first. So my last name would have been [inaudible 00:17:23]-Olayiwola and it would have been too long. And so I finally gave that up, and I don't really remember exactly why. I was just like, "If I'm going to do it, I've just got to do it now."

So once I got married, I did it right away and I changed it with everything, because having gone through that experience of trying to get my middle name to be the name that I use, you've got to do it swift incision. You know, just do it. But now, what I've started to do in the last few years, I just started to put my maiden name back parenthetically in places, so I'm like, "Nwando ([inaudible 00:17:49]) Olayiwola."

Margaux: Well, let me ask you this. You're doing a lot of administrative and business and leadership stuff. Do you see patients often?

Dr. Nwando: Well, I wouldn't say often anymore. But I do still do clinical work at San Francisco General Hospital in the refugee clinic.

Margaux: Do you go by Dr. Nwando to your patients, or how do you introduce yourself?

Dr. Nwando: Okay. So I have no consistency. I actually will say to patients, "I'm Dr. Olayiwola." And they will usually try to say it. And some will say, "Can I call you Dr. O?" And if that's easier for them, then I'm happy with that.

The name that I use in kind of more social and social media and kind of leadership circles is Dr. Nwando. I don't know how the switch went on and went off, but usually for the patients, it's Dr. Olayiwola. And it's actually honestly not really a problem. A lot of my patients have very hard last names, too, to say, so we're just both kind of like, "Okay, tell me how to say it right and I'll tell you how to say it right." And some will say, "Can I call you Dr. O?" and I'll say, "That's totally fine," and then that's pretty much the end of that.

Margaux: That's awesome. That's great. I really love that you were able to claim and feel identity with all of the names that you go by. That's awesome.

Dr. Nwando: You know, when people are kids, to be honest, we don't encourage people to really stand out.

Harjit: No.

Dr. Nwando: All you're trying do as a kid is fit in.

Margaux: Exactly. That's so true.

Dr. Nwando: And then we get older and we're like, "Be yourself, whoever you want to be. Do that."

Margaux: "Unlearn everything."

Harjit: But sometimes it even feels like that in medical school because we're like, "Past Step, then you do this. Then you do this."

Margaux: Especially third-year.

Harjit: And everything seems so like, "Wait, are we creating robots?" Everyone's one after another. And I think it's always remembering, "No, you are different and remember those things because that's what adds to you and that's what will make you be the best version of yourself."

Dr. Nwando: Yeah, you're not a Step score, right? You're not like a shelf score. I mean, you kind of are.

Margaux: But you should not be defined by that number.

Dr. Nwando: You should not be defined by that, yeah absolutely. No, you're right, yeah.

Margaux: We've just been talking a lot about learning in medical school and about diversity and inclusion and improving knowledge and always being open minded and critically thinking. And I know that you've done a minority health fellowship. Can you kind of speak to that and how that has added to your education and navigation through the system?

Dr. Nwando: Yeah, it is such a fantastic program. So it's called the Commonwealth Fund Mongan Fellowship of Minority Health Policy. And it is a joint venture between the Commonwealth Fund and Harvard Medical School and Harvard School of Public Health under the leadership of Dr. Joan Reede, who is the first African-American dean at Harvard Medical School. Just an incredible woman. We just had our 22nd anniversary of fellows. So it's a one-year fellowship that you can do after you've finished all your medical training designed to basically prepare and groom minority physicians for leadership.

Harjit: Is this any field?

Dr. Nwando: Any field.

Harjit: Really?

Dr. Nwando: Any field, yes. We should talk more.

Harjit: Yes, we should.

Dr. Nwando: It's a degree-granting program too. So you finish with either an MPH, if you don't have an MPH. If you do have an MPH already, then you finish with an MPP. You know, from day one, it's kind drilled into you that you are in this because you are going to be a leader and you're going to be a leader somewhere.

And so people are leaders in industry, in tech, in pharma, in academia, in government, in state, in politics. I mean, people go into a lot of different places and all sorts of medical clinical backgrounds. And people do it at different stages of their career. So I did it right after residency, but some people do it mid-career, so it just depends on kind of when people feel the inspiration for it.

And so what it did for me, I already had a vision for the way I wanted to build communities and do a lot of stuff, but it gave me a lot of tools into, "How do you actually make change?" And until then, I thought change is made when you vote for a president. You vote for a president and put in your senators and then you've done it.

And probably the thing that I didn't think about as much, but now has become a lifeline, is that the network that is part of that. There are five or six fellows a year, and you think about that over 20 years, you know, you've got a lot of people in this network . . .

Harjit: Yeah, that's amazing.

Dr. Nwando: . . . that are in positions of leadership all over the country.

Harjit: What a strong support system that is.

Dr. Nwando: It is fabulous.

Harjit: That sounds amazing.

Margaux: And have a community too.

Dr. Nwando: It's a real community.

Harjit: Yeah, and have that backing up, because I think it's done everywhere, right? People recommend. But having these intentions, I think it's amazing.

Dr. Nwando: Yeah. And even advice on things like you asked earlier. Like, "How do you play this game? How do you play the game and still get what you want?" Look at these institutions that are structurally designed to be racist and sexist. How do you actually do that? And so, people that have been through those challenges are people that you have kind of at your fingertips. It's amazing.

Harjit: That's so cool.

Margaux: It's awesome to know that there are programs like that that like help support and guide people.

Harjit: Yeah, and I think that community building is so important and one thing that I always believe, and I usually try to embody that, is for anyone to have power and have tools, they need to be healthy, and healthy in all ways. And that's why I think medicine can have such a great impact on these communities. I think that it's something that I hope to work for. I know that you are working on this and we are just so happy that you could come talk to us. You shared really great tools and things to think about that we can kind of move forward with in our career. Is there any closing thoughts that you had before we end out this podcast?

Dr. Nwando: It would not be good if I left without talking to you guys about one other thing, which is a program that I started called The Minority Women Professionals, our MVPs program, and it's a national conference program.

A couple years ago, I had this idea. I wanted to create these spaces for women of diverse backgrounds. And we define minority very broadly by race, ethnicity, gender identity and sexual orientation, religion, ability, disability, and kept it really broad and said, "I want to create these safe spaces for women all over the country and have them be able to just learn from each other as professionals, get tools from each other, and bring in people that have really good skills and accomplishments to kind of help people on their journey as professional women."

So that was in 2017. We kind of had our very first conference in California, and since then we've had seven all over the country. They've been, usually, 100 to 200 women of different professions.

And one of the biggest things that I've been excited about, about this, is that initially, it started off as largely women in healthcare just because of my network and my circles. For me, this has been one of the biggest highlights of my career, because I've been able to learn and have women co-learn cross-functionally and interdisciplinary way from people who are not really in their same profession. It's really amazing.

In your adult life . . . and you'll see this as you are all in medicine. As you're rising up, as you were talking earlier, you have these scripts that you follow. You do this and you take this test and you go on. And for the most part, there's not a lot of interact with people that are not in medicine in your next 10 years of life.

Margaux: Yeah, so true.

Dr. Nwando: Yeah. I mean, even people marry people in their classes. It's very hard to create a circle outside of us. So having a network of women who are in all sorts of fields doing all kinds of things has been just incredible.

And so I would encourage you and the women that listen to your podcast to build a network that's not just in medicine and try to go to some the things that are happening at the law school or at the school of the arts and just expand your horizon a little bit because you'll realize that there's a lot more out there than you realize. And some of the best ideas I've gotten for how to handle things in medicine have come from people in other places.

Margaux: That's so true. Got me back to diversity, right? This breadth of experience and . . .

Dr. Nwando: Yes, exactly. Actually, that's true. I didn't really think about that angle. Yeah, exactly.

Harjit: Yeah, that's such valuable advice I think that we don't think about often. And thank you for introducing that idea into this space.

Margaux: So, Dr. Nwando, thank you so much for taking time out of your very busy schedule to meet with us. We're so excited to share a space with you and with someone who values what we value and what we're talking about as well and kind of give us guidance into the future as we look forward to residency applications next year, which is so exciting.

Harjit: So exciting.

Margaux: And I think our talk today only further reinforces our value at Bundle of Hers of diversity coming from this breadth of ideas and experiences and different people and creating a broad network of people not just in medicine, like you were just talking about, but really questioning what's being told and taught to you and questioning your own values and pushing for your own identity and really standing out. Like you said earlier, getting mad and pushing into it when there's not that space and that representation that you want to see. So thank you so much for helping us and our listeners kind of blaze the path and reinforce this vision.

Dr. Nwando: Thank you so much. Thanks for all you guys are doing. I really, really am impressed.

Margaux: Oh, thank you.

Harjit: Thank you.

Margaux: So you can follow us if you have anything to add to this conversation or any questions for Dr. Nwando, you can follow us at Bundle of Hers on Instagram or Facebook.

Harjit: Dr. Nwando, you have an Instagram as well?

Dr. Nwando: Yes, it's @DrNwando.

Harjit: Perfect.

Dr. Nwando: Instagram and Twitter.

Margaux: And that's Nwando with an "N."

Dr. Nwando: Yes, with an "N." Thank you.

Harjit: Awesome. Thank you. Bye.

Dr. Nwando: Can we get a picture?

Margaux: Yes.

Dr. Nwando: With your headphones on.

Margaux: I'll put one on just for the picture.