Student Gabriel Catano writes about guest speaker Dr. Chiquita Collins‘ visit to the “Topics in Translational Science” class.

Introduction to Dr Chiquita Collins: Dr. Collins was appointed in September 2017 as the Inaugural Chief Diversity Officer, Vice-Dean for inclusion and Diversity in the Joe R. and Theresa Lozano Long School of Medicine, and Associate Professor of Epidemiology and Biostatistics. Under her leadership, she provides oversight on efforts to address a broad spectrum of issues pertaining to increasing respect in differences and foster inter-dialog by working directly with Department Chairs health administration to develop robust and strong policies and practices to elevate diversity and inclusion within and across all levels.  She is recognized at both, state and national levels, for her work in health disparities, primarily as it relates with social content and various societal influences that contribute with health differences among racial and ethnicities and across socioeconomic groups.  In 2016, she received the distinction of having one of the top 100 cited papers on health care disparities and research published among a period of three decades. Dr. Collins received her doctorate from University of Michigan and has been a recipient of numerous prestigious awards. She previously served at John Hopkins University School of Medicine as a Director and Associate Dean of Diversity and Cultural Competence. She is the designated institutional representative for the Association of American Medical Colleges (AAMC) group on Diversity and Inclusion (GDI) and member at large for the MCA group on Women in Medicine and Science Committee.  Dr. Collins also instituted the School of Medicine first Diversity Ground Rounds series in spring 2018, which brings the nation’s top scientists and scholars to give one-hour lectures focusing in a wide variety of diversity and inclusion issues in health care and academic medicine.

Pathway to today:

A native Chicagoan, during Dr. Collins’ graduate school training, she specialized in Social Demography, a field within Sociology. Her mentor, Dr.  David Williams, one of the most prominent scholars in health disparities research at Harvard University, provided invaluable guidance and direction which resulted in several seminal collaborative projects. Upon graduation, she returned to her alma mater, the University of Illinois at Chicago (formerly Chicago Circle) and began her first faculty position. Due to family and personal obligations, she relocated to Atlanta, GA and became a faculty member at Georgia Tech. Realizing a professional mismatch with her expertise and the institution’s strong identity as a nationally-ranked engineering school, she decided to pursue a highly competitive fellowship through the Robert Wood Johnson Foundation, in collaboration with UC Berkeley and UCSF. Selected as one of twelve nation-wide, her two-year stint in California allowed her to seek other competitive positions and thus successfully accepted a faculty position at UT Austin, yet ultimately decided to quit the academy on her own terms to pursue a job in private industry. As a director of health equity for a federal consulting firm headquartered in Ann Arbor, MI with satellite offices throughout the country, this allowed her to remain in Austin, TX and commute back and forth either to San Antonio or their Washington, DC offices.  Unfortunately, her executive position dissolved and Dr. Collins found herself out of a job and back on the market for another position. As part of her network she became aware of a position at Johns Hopkins Medical School.  Despite their need to hire a diversity specialist, after intense negotiations her position was elevated to Assistant Dean for Diversity and Cultural Competency. Within eight months, she was promoted to Associate Dean where she remained for five years until approached by a colleague about a new position at UT Health San Antonio. Dr. Jeff Jackson from the Long School of Medicine was instrumental in the recruitment of Dr. Collins to UT Health San Antonio.

What her office does?:

1. To ensure everyone, irrespective of his/her background, is respected and valued at UT Health San Antonio and the Long School of Medicine, various efforts are currently underway.
2. The Office of Inclusion and Diversity adheres to five distinct tenets in their efforts:

1. 1. Community engagement: extent by which people are creating bridges with the community
   2. Inclusive academic environment: diversity drives excellence, such as innovation.
   3. Cultural competency: to ensure providers and academic health centers offer patient care services that meet recommended standards endorsed by accreditation entities
   4. Community: Stakeholders, both internal and external, are engaged in sustainable partnerships in all efforts related to diversity and inclusion
   5. Talent management:commitment to recruit, hire, retain, and develop the most talented and superior employees available in the job market.

3. During her first few months, the Long School of Medicine embarked on its self-study or accreditation process, which is an intense and laborious task involving all senior leaders in the school.
4. Supports PRIDE Clinic, a student-initiated endeavor, which is operating successfully and serves as a resource to the community and training opportunity for learners. New initiatives are often the result of students’ ideas.
5. Offers implicit bias training.
6. Next steps are to generate a diversity dashboard to track progress and measure outcomes to help inform various constituents.

Culture: Encompasses traditions, behaviors, attitudes, languages, thoughts, beliefs, values and ways of communication that vary across population groups.  It refers to an individual’s background, customs, holidays, cooking, and other distinctions that are shared commonalities. Culture is often adopted and passed on from one generation to the next.

Cultural competence: Increasing awareness about differences among various cultures. A set of values, behaviors, attitudes and practices within a system that enables people to work effectively across cultures. The term refers to the ability to honor and respect beliefs, language, interpersonal styles and behaviors of individuals and families receiving services, as well as staff who are providing such services. As practitioners, it is important to evaluate people on an individual basis versus a collective basis.  It is critical to ask questions oppose to assuming certain cultural traits.

Why is cultural competency important?:

Dr. Joseph Betancourt of Mass General once said “We would not accept substandard competence in other areas of clinical medicine, and cultural competence should not be an exception.” If we are training in a specialty, we should be also train in the context of understanding the different ways we equip and empower ourselves to ensure people feel respected in terms of how we medical care is delivered.  One book recommended to obtain a glimpse of what happens when cultural competency is not adhered to is illustrated in Mama Might Be Better Off Dead: The Failure of Health Care in Urban America, written by journalist Laurie Abraham. The author follows a family and reports their everyday life and many of the challenges faced while navigating a health care system, particularly among individuals living in concentrated poverty, urban neighborhoods.  Countless occasions are documented by which a family is unintentionally treated differently based on the health providers’ assumptions. Another recommended book is Caring for Patients from Different Culturesby Geri-Ann Galanti, which illustrates how various cultures perceive illness and disease and how to increase awareness and improve cultural competency among health providers.

Culture Matters:

This is important from the patient’s and the practitioner’s perspective. Individuals are more inclined to seek health care from individuals whom they share commonalities, because they feel they can relate to them, feel more at ease, and more likely to trust the provider when there are shared identities.

A book from the Institute of Medicine in 2002 named “Unequal treatment: what healthcare providers need to know about racial and ethnic disparities in healthcare” is a compilation of more than 500 studies showing various maltreatments documented in the scientific literature, even after statically controlling for income, socio-economic status and other known factors. Many examples are documented to illustrate pervasive health disparities by race.  For example, African American women have the highest rate of maternal mortality, with Texas ranking # 1. Researchers are interested in identifying the root causes of such disparities.  Unfortunately, there is a long history of distrust and mistrust towards the healthcare system by certain minority populations due to unethical practices in the past.

The National Standards for Culturally and Linguistically Appropriated Services (CLAS) in Health and Health Care produced standards that are intended to advance health equality, improve quality, and help eliminate health care disparities. It contains 22 categories that help the individual to become proficient. They are color-coded from red to purple illustrating various types of characteristics by which training can help you become cultural proficient.

Activity 1.

People in the room introduced themselves.

Dr. Collins presented a series of pictures and ask the participants to write down the first thing that comes to their minds.

First picture was a pair of shiny shoes: some of the contributions were: shoes, laces, leather, yellow inside, husband, lawyer, my great-grandfather, clean, polished, professional, serious, CEO, executive, physician.

Second picture was a person wearing a pair of worn-out shoes: contributions were: homeless, tatter shoes, poor, hard-worker, financially unstable person, poor medical care, non-compliant, sad, hard times, homeless.

All the concepts shared are based on observation in real life, experience interacting with patients who might display and assumptions that are made.

Whose shoes are you wearing?  Some of us progress from a different attire, some of us are from a low income status and work our way up. We should not judge people at all.

Here in United States there is a long history of categorizing people, those individuals that does not necessarily represent my values, what is deem to be merit and standard. Things and people have certain connotations, i.e., “As American as apple pie”or ”baseball.”

The TED talk called “The secret to changing the world” by Lee Mun Wah was presented. Mr Mun Wah stayed on stage silent to allow the audience to form an impression on him. Then he spoke without any Asian’s accent as many of the participants were expecting him to do. He recounted the many times in his life he was judged for his appearance and his food, even in the early school years. His name means: ”He who writes.”  However, in U.S his name was changed to Garry to facilitate the pronunciation.  Throughout his life, he has giving up, not only his name, dress and food, but also a part of himself in an effort to fit in.

He recounted the story of Joaquin, his adopted son from Guatemala. He looks physically like a good mix between a Chinese father and a Dutch mother. He went to pre-school and people thought he was Chinese. He got compliments for being smart, but when he clarified that he was Guatemalan, then they complimented him for soccer.

Mr. Mun Wah was born in Oakland, CA and in school, he started to realize that he was different and the multiple ways he can blend in, but even with a complete mastery of the English language, he still felt as a foreigner.

Dr. Collins made a parallel between the experiences of Mr. Mun Wah and the experiences of the class participants. A common way to blend in is to hide one’s culture, losing yourself.

Implicit bias is the extension which we unintentionally treat people differently. It happens automatically and it is perpetuated. Examples presented were the “fish handshake,” people of color tending to arrive late to meeting or establishing direct eye contact.

Four Patterns of Gender Bias: 1) Women who had reached the pinnacle of their respective careers, mostly male-dominated careers, they feel that they have constantly to prove themselves to compensate, they feel judged to a higher standard; 2) “damn if you do, damn if you don’t” like walking in a tight rope. Being vocal or staying quiet can be though a decision; 3) motherhood penalty, women are told not to reveal their pregnancy status if it is not showing when interviewing as they can be perceived as not being serious about their careers; 4) Queen bee syndrome, where women in positions of authority treats subordinates more critically if they are female.

“Lean in” by Sheryl Sandberg is a book that illustrates some of the challenges she faced as a COO of Facebook.

Racial and Ethnic Biases:

U.S and the world has become more diverse than ever. It is projected that the U.S adult population will become up to 54 percent diverse by the year 2050. Black and Latino women are perceived as holding low positions, even when they are dressed as a person in a position of authority.

Own-race Bias (ORB): A commonly reported phenomenon in which people are more likely to recognize someone from their own race than any other race. “They all look alike.”

Multiple Marginalities: Women have a tendency to share vulnerabilities and marginalities and are more likely to experience implicit bias and micro-aggressions.

Unconscious Bias: Studies show that two people looking for employment, similar in their credentials but with different names, Afrocentric vs Eurocentric origin, a 50 percent or more of the participant companies are more inclined to extend the call back to the more Eurocentic name on the resume than the Afrocentric one. Similar studies found discrimination based on gender as well.  Another study evaluated sending e-mails to different researchers from prestigious universities around the country requesting research opportunities before applying to doctoral programs. They found that the requests made by gender and racial minorities were ignored at significantly higher rates than those by white males, especially at private institutions.

Microagressions: Forms that people are treated differently and are hard to identify. The term was coined by Chester M. Pierce, Professor Emeritus of Psychiatry at Harvard Medical School. Mary Rowe expanded upon that and Dr. Derald Wing Sue expanded the definition to be more inclusive.

The YouTube video “What kind of Asian are you” was presented and discussed. In this video, a jogging male is surprised to find that an Asian female speaks perfect English, however, he does not understand why the considerations about her inheritance does not apply to him in the same way. In the case of the woman applying the same standard she is been subjected to, comes out as “weird.” Dr Collins explained that this is a mockery to explain microagressions as people question the “Americanism” assuming that minorities had arrived from a different place and that they need time to process information, hence the need to be spoken very slow. This implies that the minorities are not part of the system, but different people.

Activity 3

Class was divided in two groups and gather information about a microagressions using the theme “description of intelligence” and “color blindness.” Groups were asked to answer the following questions based on the assigned theme: 1) if you had personally experienced examples of microagressions; 2) if you had observed microagressions being experimented by someone’s else; and 3) what did you do?

Dr. Collins mentioned that a national conversation about these issues is necessary. It seems more prevalent now because of the media available now to capture these instances. Although we are at a better place than 50 years ago, there are still things to do. During the dismantling of the apartheid in South Africa in 1990s, a reconciliation committee was created to bring together the parties in conflict. This was a difficult healing process. Dr. Collins shared the story about his older son accused unfairly of stealing while playing basketball. These situations affect an individual psychologically and physiologically over the course of a lifetime. One person in the class share his story about contrasting attitudes in USA and Puerto Rico. While playing basketball in the court, a group of African American persons came to play and the other individuals left the court and call security.

Ways to mitigate:How can we empower ourselves to act?

Start with yourself: Engage in critical self-reflection. Hold yourself accountable for recognizing and pushing back against your own biases before asking other to do the same. Share your own stories of vulnerability, learning and growth. Be the first to uncover and role model these behaviors to others.

Be vocal: Say to others” I am a diversity champion. I recognize I have biases and I am working to identify, acknowledge, and address them.”  The effects of these small statements will amplify as they are repeated and enacted by others across the organization.

Take risks on others: Give others –particularly those that are different from you- a chance. Be open to learning from them as much as they can expect to learn from you. Intentionally mentor and sponsor people who are not like you.

Stay connected: We all have biases that change and evolve even when we confront them. Remain committed with sustained action over time.

Get to know others: Make personal connections and spend more time learning fellow coworker’s experience in the workplace.

A YouTube video called “A Trip To The Grocery Store” showed an African American woman recounted her story when her sister-in-law paid at the store in front of her and when it was her turn, the cashier ask for additional forms of identification as well as looking for her check account number in a book. At that point, her sister-in-law stepped in and used her “white privilege” to educate the cashier about the unfairness of the situation.

This article was written by Gabriel Catano, a student in the Clinical Investigation and Translational Science program.