Exploring global health research with Dr. Jerry Bloomfield

1 00:00:00,000 --> 00:00:05,860 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills 2 00:00:05,860 --> 00:00:11,260 to build their own research program, whether or not they have a mentor. 3 00:00:11,260 --> 00:00:17,340 As clinicians, we spend a decade or more as trainees learning to take care of patients. 4 00:00:17,340 --> 00:00:22,380 When we finally start our careers, we want to build research programs, but then we find 5 00:00:22,380 --> 00:00:27,780 that our years of clinical training did not adequately prepare us to lead our research 6 00:00:27,780 --> 00:00:29,200 program. 7 00:00:29,200 --> 00:00:35,480 Through no fault of our own, we struggle to find mentors, and when we can't, we quit. 8 00:00:35,480 --> 00:00:40,580 However, clinicians hold the keys to the greatest research breakthroughs. 9 00:00:40,580 --> 00:00:46,200 For this reason, the Clinician Researcher podcast exists to give academic clinicians 10 00:00:46,200 --> 00:00:51,800 the tools to build their own research program, whether or not they have a mentor. 11 00:00:51,800 --> 00:01:01,240 Now introducing your host, Toyosi Onwuemene. 12 00:01:01,240 --> 00:01:03,060 Welcome to the Clinician Researcher podcast. 13 00:01:03,060 --> 00:01:05,000 I am your host, Toyosi Onwuemene. 14 00:01:05,000 --> 00:01:10,280 I'm excited to be here today because I have a really amazing host on the show, Dr. Jerry 15 00:01:10,280 --> 00:01:11,280 Bloomfield. 16 00:01:11,280 --> 00:01:12,280 Jerry, welcome to the show. 17 00:01:12,280 --> 00:01:13,280 Hey, Toyosi. 18 00:01:13,280 --> 00:01:15,280 Thanks for having me. 19 00:01:15,280 --> 00:01:22,440 So Jerry, you are what I would call an esteemed clinician scientist, and you may not feel 20 00:01:22,440 --> 00:01:23,440 that way. 21 00:01:23,440 --> 00:01:24,440 And I find this to be the trend. 22 00:01:24,440 --> 00:01:26,880 Most people just don't feel like they're distinguished, but they are. 23 00:01:26,880 --> 00:01:27,920 You are. 24 00:01:27,920 --> 00:01:31,680 And I wonder if you would just introduce yourself to our audience with regard to your role as 25 00:01:31,680 --> 00:01:34,960 a clinician scientist and how you came to be here. 26 00:01:34,960 --> 00:01:36,480 Thanks, Toyosi. 27 00:01:36,480 --> 00:01:38,640 You're too kind. 28 00:01:38,640 --> 00:01:41,360 My name is Jerry Bloomfield. 29 00:01:41,360 --> 00:01:47,600 I am an associate professor with tenure in the Department of Medicine in the Division 30 00:01:47,600 --> 00:01:48,880 of Cardiology. 31 00:01:48,880 --> 00:01:54,280 I'm a clinical cardiologist, and I do all the things that academic cardiologists do, 32 00:01:54,280 --> 00:01:58,760 the tripartite mission, clinical research, education. 33 00:01:58,760 --> 00:02:04,120 I also have a role within the Duke Global Health Institute, where I'm the associate 34 00:02:04,120 --> 00:02:11,280 director for research, which ties into what I do as a clinician investigator, which is 35 00:02:11,280 --> 00:02:15,200 predominantly in the global health space. 36 00:02:15,200 --> 00:02:22,440 And global health doesn't always mean international health, but most of my research portfolio 37 00:02:22,440 --> 00:02:30,840 is in low and middle income countries, as well as doing research in impoverished, underresourced 38 00:02:30,840 --> 00:02:35,040 areas of the US, particularly in the US South. 39 00:02:35,040 --> 00:02:43,960 I've been at Duke for, I think, 16 years now, four of those were during my cardiology fellowship. 40 00:02:43,960 --> 00:02:50,400 And yeah, like most clinician investigators, just keep trying to put shots on goal. 41 00:02:50,400 --> 00:02:51,680 Wow. 42 00:02:51,680 --> 00:02:54,140 So I feel like I've already learned something from you, Jerry. 43 00:02:54,140 --> 00:02:58,000 You talk about global health not always being international work. 44 00:02:58,000 --> 00:03:01,160 Could you speak more about that? 45 00:03:01,160 --> 00:03:03,040 Absolutely. 46 00:03:03,040 --> 00:03:09,660 The field of global health has evolved tremendously over the last few decades, mostly in terms 47 00:03:09,660 --> 00:03:13,520 of what our understanding of global health is. 48 00:03:13,520 --> 00:03:18,400 So we no longer really talk in terms of international health. 49 00:03:18,400 --> 00:03:22,200 We don't really talk in terms of tropical medicine. 50 00:03:22,200 --> 00:03:27,480 There's a lot of old connotations aren't really relevant as much. 51 00:03:27,480 --> 00:03:33,000 And even if our initial understanding of global health, that term really became popular 52 00:03:33,000 --> 00:03:40,040 I'd say in the early 2000s, early 2010s, where global health, as I understand it, and as 53 00:03:40,040 --> 00:03:47,120 I involved it in my research, is really a methodology of your research that addresses 54 00:03:47,120 --> 00:03:55,960 the health inequities for populations who are historically been under-resourced or experiencing 55 00:03:55,960 --> 00:03:57,940 worse health outcomes. 56 00:03:57,940 --> 00:04:02,440 On a global scale, that occurs in low and middle income countries. 57 00:04:02,440 --> 00:04:06,600 I mean, that's just, you know, that's sort of at the front door. 58 00:04:06,600 --> 00:04:12,000 However, even within higher income countries or upper middle income countries, as we know, 59 00:04:12,000 --> 00:04:18,040 take the US as an example, there are, you know, gross disparities, gross differences 60 00:04:18,040 --> 00:04:23,220 in certain regions and other ways that we sort of slice and dice society. 61 00:04:23,220 --> 00:04:30,280 So global health to me is really research that addresses vulnerable populations and 62 00:04:30,280 --> 00:04:36,240 doing things to mitigate some of these barriers to better health. 63 00:04:36,240 --> 00:04:37,240 Thank you, Jerry. 64 00:04:37,240 --> 00:04:39,880 I really appreciate you shedding light on that perspective. 65 00:04:39,880 --> 00:04:42,960 And that really does make sense in terms of it's global. 66 00:04:42,960 --> 00:04:47,840 And so if you look at it from the US perspective, you might want to think of it as internationally. 67 00:04:47,840 --> 00:04:53,480 But if we think about the whole world, it really is, it's global from that perspective, 68 00:04:53,480 --> 00:04:55,200 which is cool to think about. 69 00:04:55,200 --> 00:05:01,620 Now, many, many people want to get into global health research and find it to be difficult. 70 00:05:01,620 --> 00:05:07,280 So I'd love you to talk about your journey and how you came to be a researcher in the 71 00:05:07,280 --> 00:05:11,960 global health space and how other people potentially could think about it as they're interested 72 00:05:11,960 --> 00:05:14,160 in it. 73 00:05:14,160 --> 00:05:19,720 My journey is a circuitous one, full of providence and serendipity. 74 00:05:19,720 --> 00:05:23,920 I'll give you the short truncated version. 75 00:05:23,920 --> 00:05:32,680 I knew I wanted to be a cardiologist from back when I was in internal medicine residency. 76 00:05:32,680 --> 00:05:38,360 Because of my background and upbringing, my parents were immigrants to the US in the 1960s. 77 00:05:38,360 --> 00:05:44,840 I always had a global view of the world and global view of health. 78 00:05:44,840 --> 00:05:53,840 But during med school in the late 1990s, early 2000s, there was really no great model of 79 00:05:53,840 --> 00:06:00,000 how one incorporated international health, which was a term at the time, and cardiovascular 80 00:06:00,000 --> 00:06:01,960 disease. 81 00:06:01,960 --> 00:06:08,560 That changed for me when a friend of mine who had graduated residency a few years before 82 00:06:08,560 --> 00:06:13,000 me went to work in Kenya as a missionary doctor. 83 00:06:13,000 --> 00:06:18,680 So early 2000s, and he went to Kenya to treat HIV in a mission hospital. 84 00:06:18,680 --> 00:06:23,640 And after working there for a few years, he said, Jerry, you got to come out and see what 85 00:06:23,640 --> 00:06:28,540 life is like out here and see what we're seeing and how we're practicing medicine. 86 00:06:28,540 --> 00:06:31,360 So this was in 2003. 87 00:06:31,360 --> 00:06:36,760 And I'll tell you, Toyosia, I went out to Kijabi, Kenya, the city I was working at the 88 00:06:36,760 --> 00:06:38,260 time. 89 00:06:38,260 --> 00:06:41,840 This is back before we had smartphones and things like that. 90 00:06:41,840 --> 00:06:47,640 I went with a stack of up to date articles on treating all of the worms and all the infections 91 00:06:47,640 --> 00:06:52,800 and the manifestations of TB, expecting that that's what I would be treating in this small 92 00:06:52,800 --> 00:06:53,800 hospital. 93 00:06:53,800 --> 00:06:59,640 But in fact, honestly, what I spent most of my time doing that summer of 2003 was treating 94 00:06:59,640 --> 00:07:07,980 hypertension, diabetes, and heart failure in a very remote part of Kenya. 95 00:07:07,980 --> 00:07:14,540 So that started to put some connections in my mind to say, well, here I am with a passion 96 00:07:14,540 --> 00:07:18,340 for cardiovascular disease and CBD risk factor issues. 97 00:07:18,340 --> 00:07:24,700 And here's a place where someone like me could partner with other Kenyan physicians to actually 98 00:07:24,700 --> 00:07:27,840 do something about this burden. 99 00:07:27,840 --> 00:07:34,480 What really sort of made this fit for me, what really sort of sparked a passion for 100 00:07:34,480 --> 00:07:39,520 me for this was the fact that the patients who were having these conditions, they had 101 00:07:39,520 --> 00:07:40,920 no idea what they were. 102 00:07:40,920 --> 00:07:45,120 They didn't have the terminology for them, much less did we have medicines. 103 00:07:45,120 --> 00:07:50,720 And even physicians, they weren't attuned to cardiovascular diseases. 104 00:07:50,720 --> 00:07:56,880 So flash forward many years, I came to Duke for cardiology fellowship. 105 00:07:56,880 --> 00:08:03,520 I applied for some fellowship grants, worked with mentors to apply for larger grants to 106 00:08:03,520 --> 00:08:11,280 start a cardiovascular research program to understand what's causing all of these cardiovascular 107 00:08:11,280 --> 00:08:15,640 diseases in low and middle income countries, specifically in Kenya. 108 00:08:15,640 --> 00:08:18,440 So that's what got me started in it. 109 00:08:18,440 --> 00:08:23,960 Now, what's beneficial for folks who are interested in global health and cardiovascular disease 110 00:08:23,960 --> 00:08:29,060 these days is that we're 20 years on from that. 111 00:08:29,060 --> 00:08:34,240 So everyone or most people are aware of the global burden of disease, the global burden 112 00:08:34,240 --> 00:08:35,440 of cardiovascular disease. 113 00:08:35,440 --> 00:08:42,120 So the fact that 70 to 80% of all cardiovascular disease deaths occur in low and middle income 114 00:08:42,120 --> 00:08:49,080 countries where we've made great strides in decreasing CBD deaths in the US, in many parts 115 00:08:49,080 --> 00:08:52,080 of the world, that curve is actually on the upswing. 116 00:08:52,080 --> 00:08:59,000 So there are a lot of opportunities, both NIH funded, both foundation supported, and 117 00:08:59,000 --> 00:09:04,720 I have a lot of colleagues who use their non-professional time to go abroad to someplace where they 118 00:09:04,720 --> 00:09:08,440 have partners and an opportunity to use their skills. 119 00:09:08,440 --> 00:09:14,240 So I'd say there are a lot of roads into global health these days, and I continue to use the 120 00:09:14,240 --> 00:09:18,360 academic route and the clinician investigator route. 121 00:09:18,360 --> 00:09:19,960 That's really, really amazing. 122 00:09:19,960 --> 00:09:20,960 And thank you for sharing. 123 00:09:20,960 --> 00:09:24,080 What a remarkable story. 124 00:09:24,080 --> 00:09:31,360 I am curious to know, you talk about partners, and I think it is important as we think about 125 00:09:31,360 --> 00:09:35,960 doing this work globally, especially outside of the United States, where there's a concern 126 00:09:35,960 --> 00:09:40,520 that researchers go and they do research in a different country and then they come back 127 00:09:40,520 --> 00:09:45,240 home and the benefit of the research may not accrue to the places in which they've done 128 00:09:45,240 --> 00:09:46,240 the research. 129 00:09:46,240 --> 00:09:50,600 Can you speak to what some of those partnerships look like in terms of bringing the benefit 130 00:09:50,600 --> 00:09:53,560 back to those communities? 131 00:09:53,560 --> 00:09:56,360 You know, you hit the nail on the head, you know, parachute research. 132 00:09:56,360 --> 00:10:02,760 I mean, my goodness, we have so many examples of that, both in the cardiac space and the 133 00:10:02,760 --> 00:10:08,240 HIV care space, just a real travesty. 134 00:10:08,240 --> 00:10:16,320 I think the way you get around that is making sure that you are not bringing a solution, 135 00:10:16,320 --> 00:10:19,240 looking for a problem. 136 00:10:19,240 --> 00:10:24,440 That's really important for people coming from the U.S. specifically who haven't engaged 137 00:10:24,440 --> 00:10:26,120 in global health research. 138 00:10:26,120 --> 00:10:31,440 If often, well, I have this new tool or I have this new app, or if only folks would 139 00:10:31,440 --> 00:10:35,520 do this, then things would change and health would be better. 140 00:10:35,520 --> 00:10:39,640 What's really been instructive for me is really taking the time to listen. 141 00:10:39,640 --> 00:10:46,440 So it took me a few years of working in Kenya to really realize that I had only scratched 142 00:10:46,440 --> 00:10:52,000 the surface of what some of the health system issues were, what some of the issues that 143 00:10:52,000 --> 00:10:59,240 patients and families face, why is it that nurses weren't checking blood pressures in 144 00:10:59,240 --> 00:11:01,040 a particular hospital I was visiting? 145 00:11:01,040 --> 00:11:03,480 Well, that's because the ratio was one to 30. 146 00:11:03,480 --> 00:11:08,840 What do you expect these people to do in the middle of the night and one person gets really 147 00:11:08,840 --> 00:11:09,840 sick? 148 00:11:09,840 --> 00:11:16,240 So I think time is the real factor there and actually getting to know your partners and 149 00:11:16,240 --> 00:11:23,960 listening and sometimes just injecting a little bit of silence into the conversation 150 00:11:23,960 --> 00:11:29,600 and let that silence leave room for your partners to chime in to. 151 00:11:29,600 --> 00:11:31,560 Thank you for sharing that perspective. 152 00:11:31,560 --> 00:11:36,100 I think it is really important to, even if we're not involved in global health research, 153 00:11:36,100 --> 00:11:42,440 to think about how our work serves the people that we are working with in the research endeavors 154 00:11:42,440 --> 00:11:47,720 that we continue and how listening is so important in anything we do really. 155 00:11:47,720 --> 00:11:54,240 I wonder if you can speak to kind of how can, now you got into research in global health, 156 00:11:54,240 --> 00:11:57,200 it sounds like at the level of being a resident. 157 00:11:57,200 --> 00:12:01,760 Let's say you are interested in this from being a med student, what are opportunities 158 00:12:01,760 --> 00:12:07,520 potentially that exist for medical students or how early can people get involved? 159 00:12:07,520 --> 00:12:11,160 Yeah, that's a great question. 160 00:12:11,160 --> 00:12:15,120 And I think there are a lot of opportunities for medical students. 161 00:12:15,120 --> 00:12:21,440 Number one, I would say that a lot of programs and I'm going to focus on the on the resident 162 00:12:21,440 --> 00:12:26,360 level for a second, but I think that is an indicator for medical students for whether 163 00:12:26,360 --> 00:12:28,120 or not there'll be opportunities for you. 164 00:12:28,120 --> 00:12:34,080 A lot of residency programs now offer a global health track or a global health interest. 165 00:12:34,080 --> 00:12:40,580 And that can be anything from six weeks abroad to a whole year abroad plus clinical research 166 00:12:40,580 --> 00:12:42,380 experiences. 167 00:12:42,380 --> 00:12:49,600 So for medical students, if your institution offers a global health residency option, that 168 00:12:49,600 --> 00:12:55,600 probably means that there are trainees and faculty and administrative staff who are thinking 169 00:12:55,600 --> 00:12:58,200 about work abroad. 170 00:12:58,200 --> 00:13:01,800 So that's a place where you could plug yourself into. 171 00:13:01,800 --> 00:13:08,280 There are other programs out there actually from the NIH for medical students. 172 00:13:08,280 --> 00:13:13,720 So there is a Fogarty Global Health Scholars Program. 173 00:13:13,720 --> 00:13:17,560 There's also a Fogarty Fulbright Program. 174 00:13:17,560 --> 00:13:22,120 And they have different eligibility criteria for various stages in training. 175 00:13:22,120 --> 00:13:27,480 But there are those two programs from the NIH plus the residency programs around the 176 00:13:27,480 --> 00:13:32,120 country I think are really great opportunities for students to plug into. 177 00:13:32,120 --> 00:13:36,840 There are also private foundation opportunities and they sort of come and go. 178 00:13:36,840 --> 00:13:40,180 So I don't feel like I have a good grasp on all of them. 179 00:13:40,180 --> 00:13:45,040 But there are also private foundations that will support medical students. 180 00:13:45,040 --> 00:13:50,920 But I would say if your institution has a global health residency or faculty that are 181 00:13:50,920 --> 00:13:54,000 doing global health, that's usually a good place to start. 182 00:13:54,000 --> 00:13:55,760 I like that. 183 00:13:55,760 --> 00:13:57,280 I appreciate what you're saying. 184 00:13:57,280 --> 00:14:02,680 It's that if people are already doing this work, it's a sign that there is a way to support 185 00:14:02,680 --> 00:14:03,740 the work. 186 00:14:03,740 --> 00:14:08,140 And so perhaps it might be more challenging to go to an institution where no one is doing 187 00:14:08,140 --> 00:14:10,920 work in global health research. 188 00:14:10,920 --> 00:14:14,200 It might be harder, not impossible probably, to get started. 189 00:14:14,200 --> 00:14:18,120 But just thinking about what opportunities already exist and kind of going with the momentum 190 00:14:18,120 --> 00:14:19,920 of that as well. 191 00:14:19,920 --> 00:14:25,680 And you know, Toyos, I mean, that actually relates to advice that I give cardiology fellow 192 00:14:25,680 --> 00:14:32,360 applicants sort of at a different stage in the game where you want to go if you're interested 193 00:14:32,360 --> 00:14:36,480 in global health as part of your career, you really want to be at a place where you won't 194 00:14:36,480 --> 00:14:38,720 be the only one. 195 00:14:38,720 --> 00:14:45,160 And I remember when I was applying for fellowship way back when being told things like, well, 196 00:14:45,160 --> 00:14:49,960 we've never done this before, but we'd be happy to support you and we'll open doors 197 00:14:49,960 --> 00:14:52,680 for you and we'll support this or we'll support that. 198 00:14:52,680 --> 00:14:55,000 It was very much appreciated. 199 00:14:55,000 --> 00:15:03,280 But if you step back, you realize that that's really a program or support around you. 200 00:15:03,280 --> 00:15:08,440 What you really want is a program that's supporting the idea, supporting the theme, supporting 201 00:15:08,440 --> 00:15:10,800 global health generally. 202 00:15:10,800 --> 00:15:16,200 So I would urge folks at any stage in their training to aim for a place where there are 203 00:15:16,200 --> 00:15:22,160 other people engaged in global health and that there is a well-oiled machine, that there 204 00:15:22,160 --> 00:15:27,020 is a, continue using analogies, that there is a steam engine that is moving in a good 205 00:15:27,020 --> 00:15:32,600 direction that you can join on to, but you're not having to lay down the tracks. 206 00:15:32,600 --> 00:15:34,560 That's what we did a couple of decades ago. 207 00:15:34,560 --> 00:15:36,160 No, that's awesome. 208 00:15:36,160 --> 00:15:40,880 What I hear you speak about is really the power and the importance of community. 209 00:15:40,880 --> 00:15:46,160 And you, as much as a lot of maybe our earlier training felt like a solo endeavor, it was 210 00:15:46,160 --> 00:15:52,520 never really solo, it becomes more important as you're moving from the medical student 211 00:15:52,520 --> 00:15:57,680 to resident to fellow and to faculty transition to really be part of a community that's engaged 212 00:15:57,680 --> 00:16:02,600 because then you're able to gather a lot more resources and your chances of being successful 213 00:16:02,600 --> 00:16:03,840 are much higher. 214 00:16:03,840 --> 00:16:04,840 Absolutely. 215 00:16:04,840 --> 00:16:05,840 Absolutely. 216 00:16:05,840 --> 00:16:09,880 Now, one thing that comes to mind is that many people who are interested in global health 217 00:16:09,880 --> 00:16:12,000 research are interested for a reason. 218 00:16:12,000 --> 00:16:19,240 Or you talk about having your parents who are immigrants and there are many trainees 219 00:16:19,240 --> 00:16:23,840 or early faculty who say, well, I have roots in a certain country or I have connections 220 00:16:23,840 --> 00:16:25,320 to a certain country. 221 00:16:25,320 --> 00:16:31,280 How do you recommend they address that where perhaps there is global health research ongoing 222 00:16:31,280 --> 00:16:36,520 at their institution, but not necessarily targeted to the country of interest? 223 00:16:36,520 --> 00:16:40,000 Yeah, I've learned a lot about that. 224 00:16:40,000 --> 00:16:46,720 I have a lot of conversations with folks who have that exact same story or that interest. 225 00:16:46,720 --> 00:16:56,800 And what I've learned from those colleagues is often your childhood experiences in a particular 226 00:16:56,800 --> 00:17:02,720 country are very different from your country as your experience as a physician. 227 00:17:02,720 --> 00:17:08,760 And so oftentimes people say, I grew up in X, I'd love to go back and do something on 228 00:17:08,760 --> 00:17:13,700 the medical side, but don't really have a great sense of what the healthcare system 229 00:17:13,700 --> 00:17:21,760 is currently and how the healthcare system works and who the right partners are. 230 00:17:21,760 --> 00:17:29,920 So those are all places that I encourage people to start to understand, well, what is the 231 00:17:29,920 --> 00:17:31,840 condition you're interested in? 232 00:17:31,840 --> 00:17:33,640 What is the approach? 233 00:17:33,640 --> 00:17:34,640 Who are the partners? 234 00:17:34,640 --> 00:17:39,240 And I think if one thing that that's really where it starts there, who are the partners? 235 00:17:39,240 --> 00:17:43,280 And if you're having to find and develop partners, that's great. 236 00:17:43,280 --> 00:17:45,360 That clearly takes more time. 237 00:17:45,360 --> 00:17:51,120 But I would really start with partners and partner as you said, Toyosi, partners in the 238 00:17:51,120 --> 00:17:56,760 true sense of partnership, not just, I know the CEO of this particular hospital, so we 239 00:17:56,760 --> 00:18:04,160 can do these great things, but actually speak with people, do some focus group work, have 240 00:18:04,160 --> 00:18:09,400 some, you know, get on Zoom or a chat or coffee or something and say, well, what is it that 241 00:18:09,400 --> 00:18:13,960 me, as whatever type of professional, what can I bring to the table? 242 00:18:13,960 --> 00:18:17,800 What can I do to help this environment? 243 00:18:17,800 --> 00:18:20,800 So I think that the partnership is one. 244 00:18:20,800 --> 00:18:29,200 And that's a great rationale for again, if an institution has ongoing partnerships, they 245 00:18:29,200 --> 00:18:33,680 have a relationship with somewhere already, that that's a great place to start because 246 00:18:33,680 --> 00:18:38,200 a lot of those formative questions have already been answered. 247 00:18:38,200 --> 00:18:43,040 And I guess the last thing I'll say, this might be for folks who are, you know, maybe 248 00:18:43,040 --> 00:18:50,160 earlier on in their careers is regardless of the site that you're engaged in, the methodology 249 00:18:50,160 --> 00:18:54,480 for global health research is what's most important. 250 00:18:54,480 --> 00:18:59,020 And once you have that methodology, once you have that experience, you can transport that 251 00:18:59,020 --> 00:19:03,160 to a country of your choosing. 252 00:19:03,160 --> 00:19:08,480 But if you can't do that yet, I would say irrespective of where you work, it's really 253 00:19:08,480 --> 00:19:15,320 the experience, the methodology, the hard knocks of learning, you know, partnership 254 00:19:15,320 --> 00:19:17,040 and sustainability. 255 00:19:17,040 --> 00:19:20,920 And once you sort of get and start to get that under your belt, you can transport that 256 00:19:20,920 --> 00:19:21,920 anywhere. 257 00:19:21,920 --> 00:19:22,920 I love it. 258 00:19:22,920 --> 00:19:29,960 I hear you saying in that don't be so fixated on one country that you miss what the goal 259 00:19:29,960 --> 00:19:35,520 of starting is all about is and the importance of having a moving train that you can jump 260 00:19:35,520 --> 00:19:39,880 on so that you can learn all the methodology that's necessary. 261 00:19:39,880 --> 00:19:44,160 And so as much as you may have a goal of a certain country, you really want to think 262 00:19:44,160 --> 00:19:50,220 about where is where are the resources already and already available? 263 00:19:50,220 --> 00:19:55,280 And how can I get my feet wet, so to speak, and then ultimately, as a more senior person, 264 00:19:55,280 --> 00:19:57,640 be able to look specifically at different countries? 265 00:19:57,640 --> 00:19:58,960 Is that fair to say? 266 00:19:58,960 --> 00:20:00,280 I think so. 267 00:20:00,280 --> 00:20:10,240 And I think the other side of that coin is as if you're someone from another country 268 00:20:10,240 --> 00:20:16,560 or have roots in a country that you want to go back and work in and partner with and serve, 269 00:20:16,560 --> 00:20:22,360 oftentimes you have the ears that someone not familiar with the country would never 270 00:20:22,360 --> 00:20:23,580 have. 271 00:20:23,580 --> 00:20:30,600 And so whatever the connections are, often those connections with leaders, those folks 272 00:20:30,600 --> 00:20:38,600 in influential ministries, public health officials, professional societies, those connections, 273 00:20:38,600 --> 00:20:46,360 that is really the connective tissue between global health research and implementation. 274 00:20:46,360 --> 00:20:51,120 So I think in academic medical centers, we're great on the research side. 275 00:20:51,120 --> 00:20:55,960 But oftentimes, take someone who knows the country intimately to say, well, how do we 276 00:20:55,960 --> 00:20:58,560 move these findings into practice? 277 00:20:58,560 --> 00:21:03,520 And so I think that is a strength that a lot of people who have international roots bring 278 00:21:03,520 --> 00:21:09,200 to the table to bridge that practice gap, knowing folks who can actually take these 279 00:21:09,200 --> 00:21:10,800 things to people. 280 00:21:10,800 --> 00:21:12,840 Sure, sure. 281 00:21:12,840 --> 00:21:19,200 So I'm hearing that methodology is important, but relationships are important as well. 282 00:21:19,200 --> 00:21:23,720 And this leveraging the strengths of those relationships to move research forward is 283 00:21:23,720 --> 00:21:25,200 important as well. 284 00:21:25,200 --> 00:21:26,200 Yeah, absolutely. 285 00:21:26,200 --> 00:21:33,640 All right, Jerry, one of the things I am hearing, it almost sounds as if this has been really 286 00:21:33,640 --> 00:21:34,640 easy. 287 00:21:34,640 --> 00:21:37,640 It's been a walk in the park. 288 00:21:37,640 --> 00:21:44,200 Let's talk about some of the challenges, especially the biggest challenges along the journey. 289 00:21:44,200 --> 00:21:47,520 Oh, boy. 290 00:21:47,520 --> 00:21:49,880 I hope I haven't presented this as easy. 291 00:21:49,880 --> 00:21:52,600 It's certainly fun, but it has not been easy. 292 00:21:52,600 --> 00:21:56,840 You know, I'll speak honestly. 293 00:21:56,840 --> 00:22:03,420 Global health, especially in cardiology, it's still a relatively small field. 294 00:22:03,420 --> 00:22:10,000 I think the 10 or a dozen of us who are really engaged in this, we all know each other and 295 00:22:10,000 --> 00:22:16,640 have similar stories of trying to get our careers off the ground. 296 00:22:16,640 --> 00:22:22,440 One of the big challenges actually was, and I think this challenge actually is sort of 297 00:22:22,440 --> 00:22:27,040 irrespective of field, you know, because I think a lot of us as we get older, we develop 298 00:22:27,040 --> 00:22:31,920 a niche, something that we're really passionate about and that distinguishes us. 299 00:22:31,920 --> 00:22:39,520 And in my case, that niche of global cardiovascular health was a niche that initially was thought 300 00:22:39,520 --> 00:22:50,200 as too niche, was thought as not relevant, not significant, the career pathway was undefined. 301 00:22:50,200 --> 00:22:56,880 And as you know, as a mentor, if you have a mentee whose career pathway you can't line 302 00:22:56,880 --> 00:23:01,120 up the building block to see where this leads to success, that's going to give you some 303 00:23:01,120 --> 00:23:02,120 anxiety. 304 00:23:02,120 --> 00:23:05,160 You might caution them to do other things. 305 00:23:05,160 --> 00:23:12,120 And that's what I experienced in my trajectory and in my career development was that struggle 306 00:23:12,120 --> 00:23:16,240 to say like, this is something I am passionate about. 307 00:23:16,240 --> 00:23:21,640 This is something I have a little bit of experience with, but I need the mentorship and the institutional 308 00:23:21,640 --> 00:23:25,500 support to actually take me to the next level. 309 00:23:25,500 --> 00:23:28,040 And that was a challenge. 310 00:23:28,040 --> 00:23:31,640 And those things are critical, as you know. 311 00:23:31,640 --> 00:23:43,760 And so it took time and it took external validation to speak in terms that my mentors would understand 312 00:23:43,760 --> 00:23:46,160 that this was a valid field. 313 00:23:46,160 --> 00:23:53,100 And that's the coin of the realm, the academic currency were publications and grants. 314 00:23:53,100 --> 00:23:58,880 And so getting a few of those out early and getting some few successes early made it easier 315 00:23:58,880 --> 00:24:04,000 for mentors to say, okay, well, maybe there's actually something here. 316 00:24:04,000 --> 00:24:05,760 I appreciate what you said. 317 00:24:05,760 --> 00:24:06,760 And you're right. 318 00:24:06,760 --> 00:24:09,600 It applies to so much more than just global health research. 319 00:24:09,600 --> 00:24:15,000 It's the sense that when you have an idea of really burning passion and people don't 320 00:24:15,000 --> 00:24:20,360 see the way forward, having that external validation is helpful in having grants and 321 00:24:20,360 --> 00:24:23,200 publications is important as well. 322 00:24:23,200 --> 00:24:28,680 One of the things I found, and perhaps this is just in hematology, but sometimes, especially 323 00:24:28,680 --> 00:24:34,640 at the fellow stage, trainees don't tend to understand how important it is to get funding 324 00:24:34,640 --> 00:24:39,600 because it's never free, but it seems like being able to do research in residency is 325 00:24:39,600 --> 00:24:40,600 free. 326 00:24:40,600 --> 00:24:43,920 It's like if you get grants or you don't get grants, you still get to do your work. 327 00:24:43,920 --> 00:24:48,760 I wonder if you want to speak to why it's important for those early funding opportunities 328 00:24:48,760 --> 00:24:56,040 and those early awards and how young faculty or young trainees might want to think about 329 00:24:56,040 --> 00:24:57,040 it. 330 00:24:57,040 --> 00:25:00,400 Yeah, it's critical, so critical. 331 00:25:00,400 --> 00:25:06,840 So there's the funding in and of itself, which allows you to do things that you're passionate 332 00:25:06,840 --> 00:25:07,960 about. 333 00:25:07,960 --> 00:25:15,320 I think that external validation piece is also critical because as your name gets talked 334 00:25:15,320 --> 00:25:22,160 about higher and higher up the chains, people speak in terms that they understand and they 335 00:25:22,160 --> 00:25:23,160 digest. 336 00:25:23,160 --> 00:25:29,880 So whether it's getting good scores on grants or getting fellowship grants or even foundation 337 00:25:29,880 --> 00:25:32,780 grants, the amount is really irrelevant. 338 00:25:32,780 --> 00:25:37,840 It's really just showing that there is some external validation that there's potentially 339 00:25:37,840 --> 00:25:39,880 a future here. 340 00:25:39,880 --> 00:25:46,200 And I would say something I didn't appreciate at the time when I was a fellow in training, 341 00:25:46,200 --> 00:25:54,280 but another really important reason to start to write grants early in your career, if you 342 00:25:54,280 --> 00:26:02,160 see yourself being in an academic career, is that you need the practice. 343 00:26:02,160 --> 00:26:09,640 And you only get better writing grants as with anything else in life with practice. 344 00:26:09,640 --> 00:26:17,480 And I've really benefited from some of the institutional resources for some friendly 345 00:26:17,480 --> 00:26:22,480 peer review and various things that I know exist at many institutions to make sure that 346 00:26:22,480 --> 00:26:25,120 your grant writing is superb. 347 00:26:25,120 --> 00:26:28,600 So use the practice because you need it. 348 00:26:28,600 --> 00:26:32,640 Maybe you'll realize later on that you need it, but you certainly do need it. 349 00:26:32,640 --> 00:26:33,640 Absolutely. 350 00:26:33,640 --> 00:26:42,200 And when the risk, when it seems less risky, it's probably most important to practice because 351 00:26:42,200 --> 00:26:43,800 if you fall, it's still okay. 352 00:26:43,800 --> 00:26:48,200 But you're right, because it's kind of like I think about it in terms of when you start 353 00:26:48,200 --> 00:26:51,120 your first year of fellowship at a new institution and you don't even know where the bathrooms 354 00:26:51,120 --> 00:26:54,040 are, how can you do a good consult? 355 00:26:54,040 --> 00:26:55,720 You just don't even know where you're going. 356 00:26:55,720 --> 00:26:59,440 And so I think it's the same way with writing grants where the more you write it, the more 357 00:26:59,440 --> 00:27:03,800 all those things fall away, you really focus on the science that you're presenting. 358 00:27:03,800 --> 00:27:04,800 That's right. 359 00:27:04,800 --> 00:27:05,800 Yeah. 360 00:27:05,800 --> 00:27:06,800 Okay. 361 00:27:06,800 --> 00:27:07,800 All right. 362 00:27:07,800 --> 00:27:12,160 So I wonder for someone who maybe they finished fellowship and they didn't have those opportunities 363 00:27:12,160 --> 00:27:18,560 that you talked about, and now they are junior faculty really now trying to move their career 364 00:27:18,560 --> 00:27:19,560 forward. 365 00:27:19,560 --> 00:27:22,400 Is it ever too late to get involved in global health research? 366 00:27:22,400 --> 00:27:26,200 And if not, how do you recommend people like that move forward? 367 00:27:26,200 --> 00:27:28,880 Yeah, great, great, great question. 368 00:27:28,880 --> 00:27:30,920 So no, I don't think it's too late. 369 00:27:30,920 --> 00:27:31,920 Not at all. 370 00:27:31,920 --> 00:27:37,160 I think we, and I'll just be philosophical for just for a second. 371 00:27:37,160 --> 00:27:42,680 I think that is one of the benefits of the academy. 372 00:27:42,680 --> 00:27:49,920 One of the things that we benefit from is the ability to change our minds, our ability 373 00:27:49,920 --> 00:27:55,520 to have time, to have a little bit of mental space to say, what is it that I'm passionate 374 00:27:55,520 --> 00:27:56,920 about? 375 00:27:56,920 --> 00:28:00,960 And honestly, it's a blessing that not every career offers where you can say, how am I 376 00:28:00,960 --> 00:28:06,120 going to derive joy and passion and satisfaction from what I do? 377 00:28:06,120 --> 00:28:09,520 So that's an opportunity that we have. 378 00:28:09,520 --> 00:28:16,520 And I think if someone is feeling that global health should be more central in their career, 379 00:28:16,520 --> 00:28:18,160 you should go for it. 380 00:28:18,160 --> 00:28:21,900 Now there's no such thing as a free lunch. 381 00:28:21,900 --> 00:28:27,160 So you're going to have to put in the time and the effort to be successful, especially 382 00:28:27,160 --> 00:28:30,240 if this is a departure from something you've done before. 383 00:28:30,240 --> 00:28:34,760 And you're going to have to show that the credibility, show that stick-to-it-iveness, 384 00:28:34,760 --> 00:28:35,760 that passion. 385 00:28:35,760 --> 00:28:38,320 You're going to have to show that you can do it. 386 00:28:38,320 --> 00:28:40,120 But it's absolutely not too late. 387 00:28:40,120 --> 00:28:45,600 Again, especially at an institution where others are involved in global health, I think 388 00:28:45,600 --> 00:28:48,000 it's an easier on-ramp. 389 00:28:48,000 --> 00:28:53,840 But here's where I also say one thing that is not unique to global health, but it's certainly 390 00:28:53,840 --> 00:29:02,460 characteristic of global health, is this idea of team science and this idea of collaboration. 391 00:29:02,460 --> 00:29:11,260 By very nature of the fact that most of my research occurs in another country, that means 392 00:29:11,260 --> 00:29:17,960 that I have at least one partner, and I actually have many, who are working with me on these, 393 00:29:17,960 --> 00:29:18,960 on these projects. 394 00:29:18,960 --> 00:29:26,440 So multiple PI relationships, two, three, or four multiple PIs relationships, those 395 00:29:26,440 --> 00:29:28,040 are critical. 396 00:29:28,040 --> 00:29:33,480 And if you're starting out in global health research, maybe you're a co-investigator on 397 00:29:33,480 --> 00:29:34,800 a project. 398 00:29:34,800 --> 00:29:40,920 Maybe you're testing the waters as much as your potential collaborators are testing the 399 00:29:40,920 --> 00:29:41,920 waters. 400 00:29:41,920 --> 00:29:48,360 So I don't think it's too late, but I do think there are a lot of different ways to get engaged. 401 00:29:48,360 --> 00:29:49,360 I love it. 402 00:29:49,360 --> 00:29:50,360 I appreciate you saying that. 403 00:29:50,360 --> 00:29:53,680 Because I think in all things, and you said it isn't unique to global health, it's what 404 00:29:53,680 --> 00:29:54,960 do you want to do? 405 00:29:54,960 --> 00:29:57,480 What is it that you are most passionate about? 406 00:29:57,480 --> 00:29:59,880 And how can you work to move it forward? 407 00:29:59,880 --> 00:30:03,840 And really sometimes that's thinking creatively as far as how do you fund it? 408 00:30:03,840 --> 00:30:05,320 Who are the partners already engaged? 409 00:30:05,320 --> 00:30:07,740 How do you connect with them in moving forward? 410 00:30:07,740 --> 00:30:08,740 So thank you. 411 00:30:08,740 --> 00:30:10,240 Thank you for sharing that perspective. 412 00:30:10,240 --> 00:30:11,240 Yeah, great. 413 00:30:11,240 --> 00:30:12,240 Thank you. 414 00:30:12,240 --> 00:30:14,080 So we have come to the end of the show. 415 00:30:14,080 --> 00:30:17,600 And I'm curious to know if there's one thing that I haven't asked about that you feel is 416 00:30:17,600 --> 00:30:21,640 important to share with our audience. 417 00:30:21,640 --> 00:30:28,160 I think the one thing that has been in my mind of late is a conversation I had with 418 00:30:28,160 --> 00:30:31,320 a mentee of mine. 419 00:30:31,320 --> 00:30:39,280 And we were talking about meeting those academic milestones and going on the promotion and 420 00:30:39,280 --> 00:30:47,120 tenure pathway and how we are judged and measured along those ways. 421 00:30:47,120 --> 00:30:52,920 And we had a conversation about success and significance. 422 00:30:52,920 --> 00:31:00,600 And I think my own approach is success, sometimes that's externally defined. 423 00:31:00,600 --> 00:31:04,640 You've gotten this number of publications, these number of grants, you've become full 424 00:31:04,640 --> 00:31:09,240 professor or your dean or this or whatever it is. 425 00:31:09,240 --> 00:31:10,760 So those are externally defined. 426 00:31:10,760 --> 00:31:11,760 Those are all great things. 427 00:31:11,760 --> 00:31:12,760 Those are all good things. 428 00:31:12,760 --> 00:31:14,960 Those are, that's the world we live in. 429 00:31:14,960 --> 00:31:18,360 But I think it's not the same thing as significance. 430 00:31:18,360 --> 00:31:22,680 And I do think that those circles do overlap significantly. 431 00:31:22,680 --> 00:31:29,920 But I was encouraging my mentee, as we do the successful things, as we make our way 432 00:31:29,920 --> 00:31:34,360 through the APT process and we progress, those are all good things. 433 00:31:34,360 --> 00:31:41,320 Just to define for yourself what significance means, define for yourself, what is it that's 434 00:31:41,320 --> 00:31:46,160 going to keep me up late at night or wake me up early in the morning that I'm joyful 435 00:31:46,160 --> 00:31:47,320 about? 436 00:31:47,320 --> 00:31:52,120 What is it that's going to make me have to be away from my family sometimes when I'd 437 00:31:52,120 --> 00:31:53,200 rather be with them? 438 00:31:53,200 --> 00:31:54,200 What's drawing me to do that? 439 00:31:54,200 --> 00:31:56,120 And just remember significance. 440 00:31:56,120 --> 00:32:00,320 I think that's a good anchor. 441 00:32:00,320 --> 00:32:01,720 I appreciate you saying that. 442 00:32:01,720 --> 00:32:02,720 I like that. 443 00:32:02,720 --> 00:32:03,720 Significance. 444 00:32:03,720 --> 00:32:09,360 I think that's what we inherently, innately are shooting for as physicians, especially 445 00:32:09,360 --> 00:32:12,720 who are doing this thing as scientists. 446 00:32:12,720 --> 00:32:20,440 I wonder, and I wonder if maybe there might be a lot of this sometimes with especially 447 00:32:20,440 --> 00:32:24,880 early career folks who don't necessarily understand the metrics for success. 448 00:32:24,880 --> 00:32:30,760 To what extent is it possible to have significance without success? 449 00:32:30,760 --> 00:32:33,040 I think that's very possible. 450 00:32:33,040 --> 00:32:38,920 I'm not sure it's possible in academic medicine, given the way our current environment is set 451 00:32:38,920 --> 00:32:44,760 up, but I think my true north is significance. 452 00:32:44,760 --> 00:32:48,760 And I think if you're doing excellent work, I think if you're doing things that you're 453 00:32:48,760 --> 00:32:52,920 passionate about, the success will follow. 454 00:32:52,920 --> 00:32:57,160 I'm not saying that it's easy and that it's automatic. 455 00:32:57,160 --> 00:33:04,360 I stay up late and I sometimes, unfortunately, work on a weekend, but I think if you aim 456 00:33:04,360 --> 00:33:10,680 for significance and if you're using sound methodology, I think success will follow. 457 00:33:10,680 --> 00:33:14,800 Yeah, I do believe to a great extent there's overlap. 458 00:33:14,800 --> 00:33:19,040 I think also recognizing your environment, because you talked about whether you're doing 459 00:33:19,040 --> 00:33:23,880 that within academic medicine and recognizing your environment and recognizing what those 460 00:33:23,880 --> 00:33:30,320 metrics are, then you're able to align what you're doing with the metrics so that as you 461 00:33:30,320 --> 00:33:35,000 are pushing for significance, you're addressing all the other things as well. 462 00:33:35,000 --> 00:33:37,840 Because you certainly can do that outside of academic medicine, but if you're going 463 00:33:37,840 --> 00:33:42,560 to stay within academic medicine, then it's worth understanding what the currency of the 464 00:33:42,560 --> 00:33:47,200 environment is and trying to work to overlap the two. 465 00:33:47,200 --> 00:33:49,760 I wonder if you want to speak some more to that. 466 00:33:49,760 --> 00:33:55,160 Yeah, no, I think you can't ignore one for the other. 467 00:33:55,160 --> 00:34:01,480 And so again, if we're talking about the way academic medicine is currently, we have an 468 00:34:01,480 --> 00:34:04,920 APT system that's fairly ingrained. 469 00:34:04,920 --> 00:34:11,320 As you know, our institution is starting to think more broadly about types of scholarship 470 00:34:11,320 --> 00:34:13,920 and how we judge scholarship. 471 00:34:13,920 --> 00:34:16,360 Many institutions are. 472 00:34:16,360 --> 00:34:24,080 But I think if promotion, if success in academia is part of what you're aiming for, there are 473 00:34:24,080 --> 00:34:31,200 just certain metrics you have to be cognizant of while you also aim to do significant things 474 00:34:31,200 --> 00:34:32,760 in this world. 475 00:34:32,760 --> 00:34:33,760 Absolutely. 476 00:34:33,760 --> 00:34:34,760 Absolutely. 477 00:34:34,760 --> 00:34:38,480 It's being aware and savvy about your environment. 478 00:34:38,480 --> 00:34:39,480 I love it. 479 00:34:39,480 --> 00:34:40,480 I love it. 480 00:34:40,480 --> 00:34:41,480 Well, Jerry, thank you. 481 00:34:41,480 --> 00:34:42,480 You've shared some amazing insights. 482 00:34:42,480 --> 00:34:44,520 I want to thank you for coming on the show. 483 00:34:44,520 --> 00:34:46,600 It was my pleasure. 484 00:34:46,600 --> 00:34:47,600 Thank you for the invitation. 485 00:34:47,600 --> 00:34:51,400 All right, everyone, you've heard Dr. Bloomfield. 486 00:34:51,400 --> 00:34:55,280 He's given us some really important insights, especially with regard to thinking about global 487 00:34:55,280 --> 00:34:56,780 health research. 488 00:34:56,780 --> 00:35:01,840 If you can think of somebody else who needs to hear about this, please forward this episode. 489 00:35:01,840 --> 00:35:07,000 And we look forward to talking with you again next time on the Clinician Researcher Podcast. 490 00:35:07,000 --> 00:35:15,240 Thank you for listening. 491 00:35:15,240 --> 00:35:20,600 Thanks for listening to this episode of the Clinician Researcher Podcast, where academic 492 00:35:20,600 --> 00:35:26,120 clinicians learn the skills to build their own research program, whether or not they 493 00:35:26,120 --> 00:35:27,400 have a mentor. 494 00:35:27,400 --> 00:35:33,500 If you found the information in this episode to be helpful, don't keep it all to yourself. 495 00:35:33,500 --> 00:35:35,240 Someone else needs to hear it. 496 00:35:35,240 --> 00:35:39,280 So take a minute right now and share it. 497 00:35:39,280 --> 00:35:44,760 As you share this episode, you become part of our mission to help launch a new generation 498 00:35:44,760 --> 00:35:50,520 of clinician researchers who make transformative discoveries that change the way we do health 499 00:35:50,520 --> 00:35:51,520 care. 500 00:35:51,520 --> 00:36:16,160 A