131. Narratives in Cardiology: Health Equity, Community Based Participatory Research, & Underrepresented Minority Women Physician-Scientists with Dr. LaPrincess Brewer
Worldwide cardiovascular disease affects the lives of hundreds of millions dedicated cardio nerds everywhere are working hard to fight this global epidemic. These are their stories. Hey cardi nerds. Health inequity refers to avoidable differences in health between different groups of people in this powerful installment of the heart. Eaters narratives and cardiology series. We learn from dr la princesse brewer and opera neuro a hanes how we can convert health inequity to health equity by partnering and empowering and building bridges with members from the community. The patients themselves using community based participatory research. We learn about impactful programs that they have developed and lead with incredible success and we also discuss their perspectives as underrepresented minority women physician scientists as coined by albert. We'd like to offer a special. Thanks to dr sharon hayes endocrine michelle for being keyed mentors for the narratives series and especially for making this episode. Possible this incredible discussion is brought to you. In collaboration with the association of black cardiologists the abc's mission is to promote the prevention and treatment of cardiovascular disease including stroke in blacks and other diverse populations and to achieve health equity for all through the elimination of disparities. You may join and support. Abc at ab a ardito dot. Org friends we thank you for subscribing to and the carter's this podcast is not meant to be used for medical advice. The views expressed here do not necessarily reflect the opinions or policies of art. Employers speaker disclosures are available in the episode description. There no commercial or in kind support for this activity be showed a claim credit using the link of the episode description. We are so honored to welcome back. Dr carissa hanes one of our narratives fit advisers and to be welcoming for the very first time and hopefully not the last time dr princess poor in absolute leader and visionary when it comes to tackling disparities in the care of minority communities. I have the privilege in pleasure of introducing nurse. A hanes who's currently a third year cardi algae fellow at the university of pennsylvania. Her interests include global cardiovascular health. She has spent several years working for i. In haiti community engagement. Community based participatory research and implementation science. She is currently obtaining a master of science in health policy. She also serves as a fellow representative to the board of abc while a fellow she cofounded initiative entitled safe haircuts as we reopened philadelphia. Barbara end salons sharp which focuses on helping local predominantly black owned businesses. Stay safe during covid. Nineteen through infection mitigation education donations and cove nineteen vaccine education and mental health support. Nerissa welcome welcome to the show. Thank you so much. It's wonderful to be back and thank you for the fantastic introduction. I'm really excited for this episode. End to talk to dr brewer. Sure that excitement orissa and for what's bound to be a very special discussion. We decided to invite a very special person to actually introduce dr bernard. This person has dedicated herself to the care of women to tackling healthcare inequities. She's an advocate. For professional diversity in devoted mentor to so many dr sharon hayes fittingly is also very devoted mentor to docker poor as well as us cardiac so here is dr hayes. Introducing dr poor. Hello i'm doctor sharon hayes. I'm a non invasive cardiologist at mayo clinic in rochester minnesota. And i am thrilled to tell you a bit more about your guest today dr leprince. Brewer is a trusted and valued colleague and friend a gifted researcher and a woman of faith by day. She is a cardiologist and assistant professor in the department of cardiovascular medicine at mayo clinic in rochester minnesota. She is the first african american woman to join our staff she is also a rockstar in in the next couple of minutes. I will tell you why. I i met dr brewer when she was deciding where she would do cardiology fellowship. She had had some experience mayo clinic as a student so she knew a bit about the organization but she truly had many options in front of her. The minute i met her. I knew that she really needed to come to mayo clinic to train for many reasons but selfishly because i wanted to work with her and she did join us in twenty twelve for her clinical fellowships in cardiology and then an additional year specializing in preventive cardiology originally from north carolina. Prior to coming to mayo. Dr barua received her bachelor of science magna cum laude in chemical engineering from howard university. Then she got her. M p h from the johns hopkins bloomberg school of public health. She also spent time at the age as a post bac research training and got her. Md at the george washington university school of medicine. She completed internal medicine residency training at johns hopkins university. Where she was mentored. By dr lisa cooper and others who spurred and supported her interest in community based participatory research and baltimore flash forward to arrival in frigid town. Minnesota both the culture and climate shock from day. One at mayo. Dr brewer has focused laser lake in her research. Activities on addressing health disparities through community based behavioral interventions and for cardiovascular disease risk factor modification and racial and ethnic minority populations and in particular african americans from early in her fellowship when she started building relationships with local community in black churches to today in the middle of pandemic her charlie every clinical effort and research crushing has voted to improving the care and outcomes of those who have often been forgotten. I've been so privileged to be a small part of dr bruce career so far. She is currently principal investigator of the nih funded faith trial. Fostering african american improvement in total health. Cardiovascular health promotion intervention in partnership with african american churches. I've learned so much. With and from dr brewer. We have worked together and sharing heart. Health messages and church. Basements participated in readdress and red tyson days and work with pastors and their first lady's on a common goal to improve their health of their congregations. I watched her navigate. The ins and outs of it. An app development driving innovative research practices at mayo clinic and exploring licensing and funding sources. It has been both joy and privilege watching her shepherd the development of a culturally tailored personalized app for cardiovascular health. It has the strength of both the science and the people for whom it was intended behind it. This work has truly paid off for those engaged with dr brewer. Her foundational work in the community build trust and provided insights that preceded the covid nineteen pandemic so in these same communities face widespread misinformation woefully insufficient p p. and no access to covid nineteen testing. She jumped in to address. The highest felt needs including the development of disaster planning protocols for the churches and bringing quick turnaround covid nineteen testing facilities to the most affected and often forgotten neighborhoods through her work. She has become a nationally recognized expert and his highly sought after for advisory boards and speaking engagements and while it would take too long to list all of the awards in recognition. She's received just google for. I'll mention a few recent ones. She was twenty nineteen minnesota public radio news change maker and a twenty twenty history maker at home for the city of minneapolis and twenty twenty. She was also recognized by the national medical association. As top healthcare professional forty her community health advocacy efforts have also been featured on both local and national media including essence. Cbs pbs cnn. And the huffington post. She's an active member of the national medical association. Minnesota association of black physicians american heart association and the association of black cardiologists. And she's a fellow of the american college of cardiology and the american society of preventive cardiology. She serves on committees and advisory boards for these organizations. She gives back in many ways including becoming a dedicated mentor of junior scholars and community members and in ensuring the voices of community are heard. This means that you will see many community names next to hers. In publications as co presenters and at with her at meetings to present her science doctoral apprentice brewer has taught me much and i have been so honored and blessed to be a part of her personal and professional journey. I would be remiss if i didn't acknowledge our mutual love of small dogs. Her highly photogenic adorable. Yorkshire terrier gizmo is truly a bright spot with that i will turn it over to the cardio nerds and dr brewer. So with that doctor. Poor we are so honored to finally have you on the show and show these moments with us. Welcome thank you. i'm tearing up over here. Hearing my beloved mentor. dr hayes. Speak about our journey together. Every since i was a student all the way to now so that was fantastic. And i'm so honored and i'm just so excited and honored to have been invited today included in this wonderful initiative. So thank you for having me. Well thank you so much. And i would like for us to get started. Would you mind describing for us. What faith is and why faith was needed of course so faith is an acronym so every good cardiovascular researcher has to have an acronym for their studies actually stands for bostering african american improvement in total health and cardiovascular health and wellness program to promote cardiovascular al among racial and ethnic minority groups through innovative community based behavioral interventions. And we use a community based participatory research or are referred to from hereafter see b. pr approach to develop genuine relationships with organizations serving marginalized and socially economically disadvantaged populations in we currently have partnerships with african american churches and community health centers in rochester as well as the twin cities metro area. We have over a decade of collaborations with the african american community and track record for improving their health and just for our listeners. Cpr is a form of community engaged. Research in which community members are involved throughout the research office from conception of the research question intervention designed to actual implementation and dissemination of the findings. And i love. Cpr it really emerged. In light of the recognition that our traditional research approaches have just failed to resolve the health disparities among vulnerable populations. And just listening to my community members. They've also expressed discontentment that you know. The knowledge gained from research is not directly of benefit to them in all times. They feel exploited or us so cpr. Pr can serve as a bridge if you will to fill this gap in it also embodies team science. Because everyone's at the table working towards a collective i can give you a little bit of background about faith. It does have roots in baltimore maryland. Where i did my doctor. He's mentioned so. I'm going to start it with a class project during public. Health studies at johns hopkins and we were charged as classmates to develop a potentially sustainable community base intervention address health disparities in the surrounding community in baltimore maryland in east baltimore which is predominantly african american and as a group we felt at partnering with a trusted institutions within this community would be essential so we decided to partner with none other than the black art. We aren't with the church. That was actually just a stone's throw away from johns hopkins and you could actually see the hopkins medicines. I and interestingly no entity from hopkins had ever partner with this church on any sort of health related programming so we were right on time. The the church pastor in a welcomed us really with open arms. He was eager to develop his health ministry and he was fairly new at the church. And we co-developed attrition education program with the church pastor in auxiliary leaders to meet the needs of the congregation and i maintained a relationship with this church round my residency at hopkins unfortunately was accepted into cardiology fellowship at mayo clinic through the help and guidance of actress sharon hayes and before i let baltimore. The church. members pleaded with me and not let go of faith is that it really had an impact on the culture of the church in really cared. This with me as i transitioned here to the time Rochester minnesota in twenty thirteen endure my second year of cardiology fellowship. I was fortunate to have support from our ship directors in the department mayo clinic to then bring faith year to rochester so in all there but that's just kind of the background of where fade started. And how it got to rochester minnesota. That is very impressive. Documentary and at somebody at hopkins. Now i know that there is a real emphasis on community engagement so you may have started something or reinforce something that there needs to be worked on and actually i've had the opportunity to be on to community phone calls at of how i talk to the local neighbourhood about. What's going on kobe in the hospital out of hospital and it's a really refreshing relationship so thanks for bringing that up and it's unbelievable to imagine that you started faith as a fellow. What exactly motivated you on a personal level to start faith in the first place. Some have always had a passion for eliminating health disparities in. I've always enjoyed wade developing solutions to complex problems. And i really think the stems from my engineering background. It was one of the reasons that went into cardiology of the such. A fascinating. Feel with so many different arenas to bring your expertise that it's constantly evolving so through my public health training i was able to learn evidence based in supportive strategies to tackle health disparities and then i took those schools that i learned to apply them to develop as in another. Why if you will is to wanted to continue this. In minnesota after transitioning from maryland is. Because there's this common misconception here minnesota and really across the nation that minnesotans here are just healthiest as can be and you know. Minnesota has really been consistently designated as one of our nation's healthiest states. But when you dive. Deeper into the data in look at the differences lacks in. Minnesota are really worse off their two times more likely to die from cardiovascular disease than whites and they're less likely to have their hypertension under control. You know as we know that will place them at even greater risk or cardiovascular disease. So that's what motivated me to start and to keep faith going. I really appreciate you highlighting that doctor. Because i remember when i was growing up as a medical student and thinking about the kind of impact. I wanted to have where i wanted train. I always had this notion in my mind you know. The the areas of need are the areas that are urban. But really there's need everywhere you have to look and oftentimes not too far. I imagine orissa you found need all around you as well because i noticed some perils between faith and the incredible work that you're doing with the community engagement out of barber shops and salons over there in philadelphia. So tell me how you get involved with that. And what was your role. Sure i have always been interested in community. Engagement and listening. To dr brewers speak. I think you're right. There are a lot of parallels. I also enjoyed tackling complex issues for which solution usually involves teamwork and i participated in a few community facing initiatives. While i was in college in once at penn creek. Ovid i was involved in ece. May and they ran a program entitled cut hypertension and through Hypertension of the medical students would go into local barber shops and screen clients for hypertension. And i started working with the medical. Students says a cardiology fellow to improve screening and eventually met a medical student who would become the co founder of sharp with me. I specifically got to know a number of the barber's of very well and one barber shop owner in particular pre pandemic. His name is darrell. Thomas and he owns philly cuts in west philadelphia used to host town halls in his shop. That i would attend frequently and i greatly enjoy learning the history of west philadelphia in the needs of the community through those interactions. That is actually fascinating. Also really really inspiring orissa. Your work community clearly had a large impact on you. Why was working specifically in barber shops and salons so important to you well. Barbara shaw since salons are among the first generation of black businesses they bring financial vitality to their communities. They are more than just places where people go to get their hairstyle cut but they also service places where people socialize fellowship share information and educate one another and like the church. They are trusted entities in the community barbers in stylists have very personal relationship with their clients and they know the community very well and two parallel that after hearing some of the development that dr bruce did with faith through my own work in the community. I'm very interested in implementation science but the devil is always in the details. But what you've been able to accomplish with faith is truly extraordinary logistically. How did you establish maintain faith as a busy cardiologists awesome question. And i'm sitting here. Why be my forehead right now. You know no simple and easy be community based work is time intensive and it really takes a sincere and dedicated movement. I must say that my community partners and the communities. I've had the blessing to serve really motivate me to continue to do this work especially when it gets tough and challenging. It's not always butterflies rainbows. It's an absolute honor in privilege to work alongside amazing community partners in and just seeing how much they care about. The health and wellness of their communities is inspiring. They're truly brilliant insight fall in. They always have my back when it's really beautiful. Just looking back over the years just to see how our relationship has blossomed and oftentimes. I'll say you know what. I'm giving a talk that we did this and we did that. When discussing our work with eighth we include my community partners and dr hayes also brilliantly stated this that we were together in basements of churches developing these relationships that really grew into something much larger a really takes that investment of time and one of my colleagues consistently states that right in the middle of the work community. Is you in. I saw that totally brings home the point that you cannot do comedian gauge research alone. Thanks so much for that. And we can really appreciate the power of weei when the collective gets together and leaves the walls of whatever institution there and just beaches after their neighbors in there so much that could be accomplished. When there's that collaboration in speaking of extraordinary can you tell us a little bit more about sharp. What is sharp. How did it get started. In what needs did you hope to address surest so sharp which against stanford saint haircuts as we reopened philadelphia. Barbershops salons started after darrell thomas. The owner fully cuts which out to crystal hill of the co founder of sharp in myself and he had very specific questions about how he could keep his business cease during the pandemic and from that conversation we started to help darryl as well as a number of other businesses in the community implement proper covid nineteen safety practices in to keep themselves their businesses clients and staff safe from Quickly built a team that included students trainees faculty as well as infectious disease specialists and together we were able to create a safety blueprint for the shops. That met the see health department of philadelphia guidelines. You're also able to receive personal protective equipment. Donations from the university of pennsylvania and accenture the healthcare consulting company and in total we donated thousands of ppe items to over thirty businesses in the south west and west philadelphia area and another important thing to mention. Is that since the beginning of the pandemic forty percents minority owned small businesses have been closed. We also know that these communities have been disproportionately impacted by covid nineteen. So in the words of darrell. Thomas barber shop owner. The businesses and the community at large have been suffering a physical as well as a financial death and so due to the financial toll. We also organized grant writing sessions with the net at pen to help the coalition of businesses in west philadelphia apply for governmental financial relief. Wow this is a you know in this whole pandemic era new this is so much newness so much adjusting and so it's really really valuable to attack some of these issues and get them to make a big difference. What challenges have you had while starting and running sharp so some of the challenges that i have had our juggling a busy clinical schedule as a fellow. I'm also currently getting a master so a full course load and trying to help the community at the same time so like after look prince brewer said. It's very difficult. It's a lot of work but we do it because we're very passionate and cared deeply about the community. You can't do this kind of work and put so much time and effort into this. If this were a calling there was something. Dr bursts said earlier. that really stuck with me declaration. You said something about the community. That i've had the blessing to serve. Is that combination of words as does nothing self-aggrandizing or self promotional about that about serving the community. It's about taking care of people around you. You're such a gift. Both you guys such gifts to the communities that you're serving but you like you're the blessed what i've heard nerissa speak in very similar language. So it's really touching very inspiring and moving to to promote this kind of work. So i just have to congratulate universal for all of this incredible worth. You're doing with sharp. The support you provide as committee is just invaluable in that you were able to design and execute it. All fellow is inspiring to say the least so speaking of meeting people where they're at and lifting that community tucker. How did you decide to partner specifically with a black faith community. Thank you so much for your kind words again. It definitely is a blessing and you do have to have a colleague to do this. Work as imaging there are challenges in as orissa mentioned having your community partners working alongside. You really makes this worthwhile. So i really wanted to congratulate her on her work with sharp end barbershops and salons so you know we partner with the black faith community or what we fondly referred to as the black church because it's been the longstanding institutional backbone of african american community and in my opinion it was the unprecedented social networking platform among african americans. So everyone looks at the church. You know what's going on in the community and long is long before there was any you know. Social networking like black twitter. I was honored to collaborate with a scholar and health equity research leader. Dr david williams recently on an editorial published in the american journal public health and twenty. Nineteen minute highlighted. How the black church. In faith based organizations really have been at the forefront of health promotion through community based interventions in underserved communities since its inception hundreds of years ago and there have been several successful community based interventions delivered in partnership with african american churches even prior to faith that we have modeled that have improved cardiovascular risk of faith community in african american. So why not the black church. I guess is the question. It's the centerpiece of african american community. Why not the black church. Indeed and whatnot barbershops also underestimates them in other the fulcrum of the community so for this committee engagement to be successful impactful effective. You need to gain the trust of the people you need to have buy in from them. They need to believe that you have their best interests at heart so for both faith and for sharp power. These projects initially received by the community. And did you find yourself. Welcomed with open arms. Or did you have to build that trust over time before you could have that impact. I love this question because it really speaks to the process au community engagement and humility. And what that means in how you have to carry that with you while doing this type of work. So faith was welcome with open arms during the early days in baltimore and i believe this was likely due to our approach of meeting our flagship church there in east baltimore where they were and asking them directly. What would your congregation wants in a health promotion program rather than going in saying. Hey we have this and this for you. This is what you need to do. We ask them. What do you want and also having buy and from the church. Pastor to bring the program into the church was also key however interestingly. I was not welcome with open arms initially to the rochester minnesota faith community although i had initial buying from the church pastors as they wanted to improve the health of their members. This was not the case from the actual congregation members. So i can clearly see it now. During my first meetings with the congregations whole there was clear skepticism towards me. I received so many questions and kind of side. I looks of kind of why are you here. Why did mayo clinic in utah. Church and also distinctly. Remember someone telling me to sit down. And i didn't take that personally as i was actually standing up and showing a powerpoint slides and a sued but it really was a teachable moment that you have to kind of shed all that back take that off in. Just sit down and really meet people where they are and look at the items in you can only imagine how shocked i you know as black physician to to be on the receiving end of these comments and in a in a church of all places in although there were comments about prior historical at the coal research. Wrong smell like tuskegee. Syphilis study and in my opinion this skepticism actually was stemmed from a lack of outreach if you will historically by our institutions at this community which led to their distrust of my intentions so i knew there was a huge elephant in the room at needed to be addressed so i actually took a step back from the research itself in. Actually listen to them. In del deeper into their concerns in overtime we develop a trusting relationship in my biggest adversaries are my biggest cheerleaders and they wanted to know that i was in this process for the long run and not just a hit and run to data to advance my career. Why this whole story and process that you went through sounds is is nothing that i would have necessarily expected for sharp. Initially we were well received because in many ways the community reached out to us for help. But i i will say that. It took a while to develop the relationship with the shops and with the barber's stylists through Hypertension so those relationships were built over a number of years so that when the pandemic hit they felt comfortable reaching out to us for assistance. We eventually were well received by the majority of the coalition of businesses because we were introduced to them by daryl right and so they trusted him. He trusted us by proxy redan accepted by route. But i i will echo the sentiments of dr brewer. We did also encounter some skepticism at first due to historical lack of outreach and and so we had to definitely overcome that you know tried to show that we although we're physicians and there's a history of lack of maybe outreach. From a number of institutions across the country. We were there to help and to do best we could for the community you know these parallels and also the contrast between two startup stories or your origin stories. Working with the community are very interesting and and obviously no place is alike Would you have been able to do and achieve has is absolutely amazing. And i'm sure there are many other cities out there. That could benefit from having innovators collaborators in people with so much heart and passion such as yourselves and you know just hearing those stories before may really inform what you'd answer me to this next part but what would you say to others hoping to bridge gaps in care connect with communities however they begin like what would be a good strategic way to initiate a program. Such as the ones that you've started. So i must say that really conducting this type of work is not easy but as we both have expressed it's so fulfilling and it is not for the faint of heart as you really have to learn to be adaptable in have cultural humility. If you will and you have a genuine heart and commitment to the community and keen ability to listen because immunity can see right through those engines. Been through so much themselves at. They know when you are not sincere. And i'm very over protective. Do of our community members is. I really wanna make sure that they're not taken advantage of but instead that they're partnered with by those that are really interested in doing this type of work and i really would tell others interested in community engaged research or even along the full spectrum to cpr to really begin within introspective reflection on. Really why do you want do this type of work and then take time to build relationships with and understand the culture of the population that you want to serve. And i always find it difficult when people say oh you know. That's a hard to reach ovulation. They're just so hard to reach but always respond and say have you tried hard enough to reach them and and that really makes people reflect on why they want to do this and how they are going about doing. This work agree with dr completely in. I will say that having worked on sharp for while in order for community level programs to be effective. It's important for them to be well. Resourced which is sometimes an issue and community members should have a seat at the table and there needs to be trust without trust. You have nothing. There needs to be positive relationship building with respect understanding and humility in order to build trust and to develop powerful impactful relationships in at the end of the day no change moves at the speed of trust. So unless you have bat it's not going to be an effective of ineffective program that makes a lot of sense. You know we talk about building a therapeutic alliance with our individual patients but you're talking about is really fostering beth therapeutic alliance with the community as a whole so. I wanted to ask a question that came up in my mind after reading the paper. Hashtag me who by dr michelle albert. The president of the association for black cardiologists at ritchie wrote about some of the challenges unique to underrepresented minority women physicians scientists in. I'll quote from that paper. Many your m faculty are often pulled between passion or obligation for providing clinical care at the community level which arguably has positive health benefits to both providers and patients and an interest in academic endeavors the current model that isolates academia for practice fails the needs of patients providers and communities. I think what she was getting at. Is this sort of academic ascension right dislike tenure track to becoming a professor doesn't always prioritize patient care or community service and in parallel to that grant funding nih funding doesn't necessarily prioritize research into health. Inequities but dr board. Just it's just incredible. How effectively you've paired your passion and zeal for community service and improving the health of underserved populations with academic achievement the recognition that you're bringing into. This area is so admirable. And i'm wondering what would you say to so many young as people like nora saw or people who maybe are haven't had as much as she meant as neuroscience had who who are so passionate about community service in taking care of people who are underserved but maybe are discouraged by what they see around them in terms of how you know what's prioritized in terms of academic achievement. What would you say to those bright young trainees who who are future leaders medicine. He has thank you so much. I mean this is great to have opportunity to speak on especially after reading the city of dr michelle. Albert's of editorial and commentary on this piece. And i oftentimes tell my colleagues on that are also african american cardiologists physicians that she was speaking directly to me and i said i really wish that she would have had a case study. You know kind of at the very end of her paper to highlight You know my story to but she Definitely resonated with me. But i would give advice to others really trying to navigate academia and trying to balance their values. And what's most important to them from a research in community outreach standpoint is that you can integrate these together. I have clearly been able to do that have been able to merge not only my public health population health community engagement in service interests with my love of preventive cardiology and and training. So it can't be done but you really just have to. You know at one of the questions. Presented was the recipe for success. I i must say that. Once i stopped comparing myself to others as away from my own personal development. I became more confident in my abilities to do this type of work. And fortunately i've been able to become an accomplished cardiologists and community leader and advocate. But unfortunately competitiveness is really ingrained in our medical training. And you know it's really something that we have to overcome. But really i just encourage those that are interested in this type of work that can be done. It can be recognized as true science and not just service and you can feel fulfilled and also be rewarded for the time and effort that you put into thank you so much for and if i might make an observation you strike me as someone who's not driven by these external rewards of being recognized but rather going back that language use yourself feeling blessed to be able to serve the community. It's it's that calling and everything else is sort of the fruits of labour but the primary goal is calling to serve the community. You know but there is a way to to be recognized and appropriately so that climate academic ranks. Because that's also important to to carry the work forward mentor others to inspire to do similarly on the topic of dr michel. I have to say we feel so fortunate to also be able to call her in adviser especially for this narrative series. We've been so touched and inspired by the work that the for black cardiologists have been doing very impactful and so your fellow member of a board. Why do you think that the abc is uniquely important. In how has it helped your career l. Thank you for that question. Michelle albarn was well as Princess borough phenomenal. Mentors and i will say that. Abc is unique because as an organization it has focused on health equity diversity and inclusion for nearly fifty years and achieving equity is a core mission of the abc is also unique because it provides access to a network of professionals were deeply passionate about the wellness and health of vulnerable communities in many members such as dr la prince's brewer have made achieving health equity their life's work. The abc has helped me in my career in professional development tremendously through abc have received sponsorship mentorship in scholarly opportunities have also participated in several national talks and hosted events. So these experiences have helped to develop my professional confidence and my professional sense of self. If i'm going to be honest. I think that i am stronger. And more confident as a speaker researcher in leader in large part due to my participation. Abc nervosa in. That's really powerful to hear how the abc actually provides a community for you and a nurturing community at that which really is. It's almost like full cycle in terms of what you're doing for your local communities you know we've heard a lot about your passions and work in the community service base and also community engagement and we'd like to now take a few moments in the second part of this discussion to get to know both of you on a personal level and learn what we call your narratives in cardiology. So nervosa dr brewer. Do you recall what was the moment. You decided that you would become a cardiologists e. So my a ha moment if you will was actually when i was in undergrad at howard university i actually took my summer to complete a summer. Research program at duke university. And i worked with a cardiologist. Who was a physician. Scientists and the fact that this cardiologists was able to balance both patient care and also research was just fascinating to me and i at that moment realized that i could merge kind of my desire to give back in that human touch that i was missing with my engineering studies in vengeance. Bridge that into madison. So that was my aha moment in to see that i was also able to integrate. My engineering background into cardiology was the hemodialysis. Mx and just the teamwork. That's involved was of cardiology and again as i mentioned the constant evolution in discovery of cardiology. I was totally in nerissa. You talk to us in the past how you got interested for some medicine through a pipeline program. Would you mind sharing a little bit about that. Sure so. I think the first time that i had an inkling or an idea that i may wanna be cardiologists was when i was in high school and i participated in a program called health preparation explosion recruitment program each and dr woody lee at yale ran the program. He was a cardiologist and he took me under his wing and left a lasting impression on me and i remember wanting to be just like him and due to that early mentorship. I was drawn to cardiology from a young age. That's really incredible and returning back to that paper by doc. Michelle albert hashtag me. Who i'd like to read an excerpt. She wrote that underrepresented women physician. Scientists are isolated because of a lack of critical mass by boats. Sex and race. Ethnicity women and your ems represent only fifteen percent and two to four percent of cardiologists respectively. He subsequent isolation impedes the social engagement necessary for academic and personal success drivers of this isolation include are not limited to lack of racial and ethnic diversity racial and ethnic discrimination from patients and families bias from superiors and colleagues. A hyper vigilance from stereotype threat. Reactions to tokenism and in some cases misguided promotion of only one year end as being successful for minority women. These experiences are further amplified by social environments. Which may create an paraphrasing which may create a circumstance that promotes lack of shared social experience. With on your women and successful men of any race or ethnicity so this is a pretty loaded excerpt but docteur are there elements of this that you find relatable yes definitely so as i mentioned you know when i was reading this phenomenal work. It truly resonated with me. Because i could see myself interwoven into many of the lines of dr. Albert's abor many of the challenges that you pointed out from this expert. I've dealt with them sure. Dr hanes has also felt throughout her training as a cardiology fellow as well and it really highlighted sometimes. It's lonely at the top right. You know we use accomplish so much In it took so much for us to get here but actually when you actually get there you know. They're they're not that many underrepresented minorities in cardiology. But i think this actually brings home. The point at the risk of mentioned that organizations such as association of black cardiologists are so fiddle to our success. Because they do foster that nurturing environment and we do the others that look like us and we can be supportive of one another in afford each other opportunities again. It's a blessing to be a part of this ocean of black cardiologists. And as orissa mentioned. I've also had several opportunities that have emerged from my membership in abc. In i've really had the honor of meeting several. Abc founders and just seeing their vision of achieving health equity is really motivated me to keep pushing forward into see african american women in leadership within abc such as that michelle albert really relieves inspiring in really makes the salt. Worthwhile agree with everything That dr brewer mentioned and everything that dr albert wrote elephant in her piece. It can be very challenging for a number of reasons as a m. It is lonely at the top especially when you know. You don't frequently Get to work with people who look like you. But you know. I'm encouraged because of my patients I think that our presence my presence Dr brewers presence in just having a diverse core of physicians and cardiologists is important. Right we should reflect our patient population because it makes a difference to them And i can't tell you how many times i've had patients told me that. Another proud of me. They're so happy to see me there because of the historical klein that many demographic groups have had to do in order to be able to say that their physicians to reach this point. And so again. I i completely agree with dr burin. Dr albert and i'm also very grateful for them and for the abc for that reason because it does provide a network of professionals. Who understand exactly what you are going through. As a training end and how difficult it can be sometimes and for that reason is very helpful to have associations such as of archaeologists. Thank you both so much for sharing this powerful perspectives. And what i heard both of you say is that it's lonely at the top and i get this impression that there are a lot of people feeling. Lonely is simultaneously at just not realizing that this is such a shared experience that others have as well. So while you know the numbers within our micro environments are not great there there is power in community and power in numbers from the global scale. And this is actually one of the motivation for the narrative. Series is to share that people don't have to feel lonely and isolated that these experiences that you both are sharing our shared experiences and it's important to talk about it you know it's like dr manning told us once he don't know you don't talk about right so that thought in mind doctor. What would you want to say to someone who maybe earlier in the career and is feeling lonely. Maybe doesn't have a lot of support in their micro environment. Or maybe alternatively what would you say to yourself when you were younger and just trying to figure out life you know growing up in medicine you know. I i would just say stay encouraged. Even as as i mentioned really have to yourself sometimes to keep going really go back to the foundation of why you're doing this and i think in parallel nerissa and i always go back to our patients in our communities and wanting to contribute to the greater good lord of society. And that is what motivates me in keeps me going and knowing that i'm not alone. I have this whole community wrapping their arms around me cheering me on as i'm going on to improve the health of our communities so i would just say really to stay encouraged. We're here to support each other although we may be few in number. We're we're great in the support that we can provide to win another you both strike me as people who assess current situation make changes in look forward to the future. So dr brewer. What you say. The future of cardiology looks. Like i would definitely say. The feature. Cardiology is more diverse more welcoming and continuing to evolve and i would say it's also becoming more community engaged in focused towards achieving cardiovascular health equity for all that is a future i'd like to be a toast to the Rate so again. Thank you dr brewer for joining us. Today this has been a fantastic discussion. And dr brewer. I cannot begin to tell you how encouraging your words have been for me. You've motivated me to keep going. And i'm sure you will inspire many of our listeners. As well thank you for the fantastic work that you do and for the trail that you are blazing so that people like me can have someone to follow and thank you again for joining us. Thank you again. It was truly a pleasure. Honor and a blessing data thinking muted guy unneeded to. I was so charming. You guys will miss that. I'm sorry i'll start again.