T. Salewa Oseni, MD: Discipline and Diversity in Medicine

 Q:  The lack of diversity in medicine, and the role it plays in perpetuating healthcare disparities, is a central conversation in healthcare today. Dr. T. Salewa Oseni, breast surgical oncologist at Mass. General, knows that, when a team caring for patients of all backgrounds does not also reflect the same inclusivity amongst its members, the quality of care suffers. As the co-director of the Diversity, Equity, and Inclusion Committee in the Mass. General Department of Surgery, much of Salewa’s work is dedicated to changing the face of medicine, to become more reflective of the diverse patient population it serves.

Cultural competence, she says, is the cornerstone to eliminating healthcare disparities and advancing patient care. As a former surgeon in the United States Navy for 13 years, Salewa learned early on in her career the value in working and collaborating on a team comprised of people from all walks of life. 

Since joining Mass. General in 2017, she has become a vocal advocate for cultivating a community of rich diversity and inclusivity. 

Q:   So welcome, Salewa. It’s so wonderful to have you here today. 

A:   Thank you so much for having me, Kelsey. 

Q:   So the Navy, I have so many questions I wonder if we could start with you talking a little bit about what motivated you to become a Navy doctor.

A:   So when I was finishing up my undergrad with engineering, I had pretty much decided that I wanted to do medicine. But the cost of medical school can be exorbitant. And so I was thinking about other ways of financing this. I had attended one of those recruiting sessions for the Army Corps of Engineers. 

And, the gentleman I was talking to, I wanted to let him know that I didn’t want to waste his time giving me the sales pitch, since I was pretty sure I wasn’t going to be an engineer.  And told him that I was going into medicine, and he could see about recruiting someone else. He then offered to tell me about the Army scholarships that they had for people who wanted to study medicine. 

I decided to go with the Navy, I wanted to travel, see the world. And they had bases in cool places. So I ended up doing the health professions scholarship program with the Navy.

Q:   That’s incredible. So you joined the Navy. You're there. What’s it like in the very beginning?

A:  At the time you're going through it, it’s a combination of, what did I get myself into? Why am I doing this? And how am I going to get through this?

But it’s an awesome experience. You get to work as part of a team, working towards a singular goal. You get to meet people from all parts of the US. I still have friends, from the military, that I made during my almost 15 years in the service, who come from all the different parts of the country. And so that’s an awesome experience. And it’s also challenging, as you learn to adapt to the different areas that you find yourself in situations.

Q:   Sure. So you had these questions, it sounds like, running through your head, when you first started, which is, why am I here? What am I doing? How did you find your own answers to those? 

A:   So I think for all the training, there's a very physical part of it. And I didn’t think about that aspect. I wasn’t the most physically active person. So every time we would wake up at five a.m. for those runs, that would be when the question would come in, like, “Why are we doing this again?” 

Over the time, I ended up liking the discipline, the focus, and the challenge it presented, because it does push you to, as the Army likes to say, be all you can be. I certainly thought to myself, if you can make it through this, medical school is going to be a cake walk. Or at least it gives you a skill set that is hard to match anywhere else.

Q:   Yeah. Has the rigor that you learned so early on, served you throughout your career as a surgeon? 

A:   Oh, definitely. I would say it has been incredible. I think the focus and discipline that you need is certainly that translates easily to surgery, and to medicine. But also, especially medicine now, working on a team, learning to work with others, learning to overcome obstacles. 

I think I had mentioned to a friend that over the spring, when we had the lockdown and the coronavirus, surge here in Boston, basically what the hospital did to get ready seemed, to me, like a predeployment phase. The rhythms were very familiar, trying to figure out the problem, the scope of it, getting into gear, breaking up into teams, developing plans to address them.

This was very much familiar to me. It seemed like the routines we would go through, as we anticipated deployments. And even when you do get out into the field. I did three deployments, one with an aircraft carrier, one with the First Med Division, and one with the Army. And it was a very similar process. And this spring was reminiscent of that.

Q:   I'm curious if you can share more to just about the people that you met during your time in the Navy. You mentioned that people are coming from all over, from all backgrounds. Was that surprising to you?

A:  The military was a very diverse environment. And I didn’t think about it as much  while I was in there, because that’s what you see day in, day out. But I definitely appreciated it a lot more after I left. And certainly, when I joined Mass. General.

I think that what's great about it, and challenging at the same time, is that for example, my first deployment you have the medical unit. And there's going to be anywhere from 15 to 20 of you. There's a surgical team as part of that. 

So you comprise of a four or five-man unit. And then you're part of a larger entire medical unit that is another 20 to 30 personnel. And you're all coming from different bases, in the US. Many of you may be meeting each other for the first time.

And you go through this four to six week process. My first one, I did it at Fort Jackson. Where you essentially have to learn about each other, learn to work as a team. Because after that six weeks, you get deployed as one unit somewhere, for six to eight months. 

Q:   Yeah, it sounds like having that trust and those relationships between each other is a really integral part of it. Was that something easy for you to develop with other people? Was that just sort of an expectation?

A:  I think the expectation that you're all working for a particular purpose is there, and that you're all going to give it your best is there. And that makes it a lot easier. You're starting off with a level of trust that you expect, unless there is something untoward that happens, that makes you question that. 

And I think that level of trust is, is needed, because. These are the people you're going to see day in, day out. You want to get to know your teammates, because you can't function as a well oiled unit if that isn't there.

And in working with those people, you learn about them. You learn about how they work. They learn about you. And hopefully, you make each other better.

Q:   And so what drew you to the specialty that you're in, into surgical oncology?

A:   So I would say that I initially thought about doing GYN onc. I was very interested in women’s health. After my OB rotation, I decided that maybe straight OB and GYN onc was not for me. And so I looked towards surgical oncology.

With my focus on breast cancer, you're meeting patients at a time in their life when they hear the “c” word, and it can be overwhelming. And the next question is usually, you know, “Am I going to make it?” 

And you have the ability to help them navigate one of the most challenging courses in their life, and get out on the other side, hopefully successfully. It’s an amazing feeling. And there's nothing like it. I always think it’s a privilege.

Q:   Yeah. So I've heard that surgery has a reputation for being a male-dominated field. Was this your experience in the Navy, or throughout your career in general?

A:   Yes, in many ways.It has been. I think one of the things I do enjoy about being at Mass. General, is that we have, a well balanced team, certainly in surgical oncology. 

Over the time in the military and training, and certainly in Fellowship, I've seen more women come into the field. But when I first started off as a medical student, I think the overwhelming perception was that, you know, surgery was a difficult field. And you had to be tough. 

And I think for me, it’s something I clearly wanted to do. But that was definitely not my personality. 

And so it was finding, finding that balance. How do I navigate doing what I want to do, but not having to do it in that particular way? And I was lucky enough that certainly, as I went through residency, I found some female mentors along the way, who showed an alternate vision of what a surgeon’s life could be. 

And in the military, my first deployment, I think they were expecting a male surgeon, and so were surprised when I showed up as as a woman. And my name does not give it away that I'm a woman. So I could sort of understand their surprise. But at the time, I thought to myself, this is the 2000s. This is not a surprise. You should see what's coming after me. This is an adjustment that surgery is going to have to make.

And I would say that we’re certainly making it, because in the last few years, almost 50 percent of the incoming surgical class has been female. 

Q:   So when you saw that surprise on their faces, what was your reaction? Or how did you—how did you internalize that?

A:  So there was obviously disappointment, because this was my first, you know, this was my first deployment. And so I was very excited. And the thought that, you guys were were not as excited to have me? That’s so depressing. 

I definitely thought to myself, oh you just have to see when I operate. Then you’ll know that I'm an awesome surgeon, and everything is going to be okay. 

And I think the funny thing with that, first deployment, I learned that it’s not just the surgery. I was just so focused on making sure that I was technically a good surgeon, but there's so much other leadership that comes with it. 

And so the competence, for the most part, is assumed. The leadership, making sure that the corpsmen and women that you're working with, that they're skilled, that they're going through training, mass casualty drills, that everyone is ready, those are things that I wasn’t quite aware of. And so that was a challenge.

Q:   Wow. So when you decided to leave the military and come to Mass. General, what was the most striking difference for you?

A:   Until I joined Mass. General, I had pretty much, for the most part, been in the military health system, and so there was that adjustment in now working in a predominantly civilian environment. 

But I think, also, workforce diversity, because I was used to being around a diverse group, of having a lot of female leadership within the service, I was a little surprised when I came to Mass. General, that that was not quite reflected in the work environment. 

Q:   So what was your approach to that, once you felt that, once you saw that and came here, what did you do from there?

A:   So it’s certainly one of the things that made me think about applying for this position when the Department of Surgery decided to, to restand the Diversity, Equity, and Inclusion Committee. Because I do think that it’s important that the workforce reflect the diversity of the population that it serves, and the population around it. 

And I wanted to be you know, part of changing that.

I thought to myself, there are multiple ways you can go about it. Two ways certainly we want to focus on, is recruiting a diverse residency and training class. 

I think that a lot of times, when people think about diversifying your workforce, there is an assumption that you have to alter your standards. And that’s not the case. We still see excellence from our applicants. And so I think it’s more redirecting your focus on what are you looking for.

And then the second part of that is outreach to the community. The Department of Surgery has a community health initiative. And I wanted to expand on that. I think I have tried to go about that with working with some of the organizations in the city that target underrepresented minority women in particular, such as community conversations, or Resilient Sisterhood Project. 

And especially, I think, in the face of the COVID pandemic. We definitely want to have more of a presence in the community. And you know, to show that we’re here, and we want to take care of all of those around us.

Q:   You said something earlier that strikes me. And there's a perception that people have to alter their standards in order to foster more diversity. Can you explain what that means? 

A:  To be frank, when you talk about workforce diversity the responses that I would hear sometimes would be that we don’t have qualified individuals. 

That’s untrue. As a woman, as an underrepresented minority in medicine, in surgery, I certainly see, through national organizations, and through our network, a lot of qualified candidates who are available for recruitment.

When we look at the medical school applicants that we have, you have applicants from various backgrounds, who also have stellar academic records, who have impressive research backgrounds, and who would be excellent candidates to recruit anywhere in the country.

And so the question, for me, isn't, are there qualified candidates out there? No. The question is, what can we do to make sure the environment that we’re recruiting to, is an inclusive one, is one that fosters diversity, that amplifies their best qualities, so that they want to come here?

And I have no found the problem to be a lack of qualified applicants. That’s not saying that there are not pipeline problems. And we want to see more underrepresented minorities, within STEM, and certainly in academia. But that’s also something for us to look at, is when you have a lot of these candidates, they may choose not to go into academic medicine. They may choose not to go into surgery. 

And part of that should be us evaluating why, and what are some of the ways that we can make sure that, as a specialty, we seem welcoming. 

Q:   So when you would hear this kind of response, what was your experience with calling it out, or bringing this conversation to the table?

A:   Well, I just asked people, you know, “where have you looked?” In general, we are all comfortable with people who look like us, who have obvious similar traits to us. 

When you're recruiting, I think the default is, “Oh, I see this person. They look like me. I know where they're coming from. They're a good fit.” You can have people who don’t look like you, who come from a completely different background, who may also be a good fit. 

It might be a little bit more uncomfortable. Or you might have to get to know them, make more of an effort. I think that we may shy away from doing that work, which is why we just default to, ah. This is someone who I recognize. This is someone who’s similar. And I am just going to go with what I know.

And when you do that, you're not going to end up with diversity.

And the diversity and inclusion I think now, as two important pieces that fit together, because while a lot of environments have made an effort to be diverse, what you don’t want to do is just recruit diversity for diversity’s sake, just to say that you’ve done that. 

Those people that you recruit are not going to thrive if they also don’t feel included. 

It’s not just having a diverse workforce, it’s also having inclusivity. And that means they don’t have to assimilate to what the environment is. But they can be who they are in that environment, and thrive. 

Q:   Completely. And so I'm hearing how all of this can have an impact, internally. How does more representation, stronger diversity, how does that impact patient care?

A:   So I think that with patient care, there are a few things that we have seen. Number one, patients are more likely to be engaged in their care when they have a diverse workforce. There are good studies that show that a concordance between physician and patients leads to improved patient outcomes in certain circumstances. 

I always think that’s great data. But I never want us to focus on that, because our goal isn't going for segregated care, where a particular group has to take care of a particular group. But when we speak about cultural competency, having a diverse workforce, we think, indirectly helps that. 

Because you get to work with a diverse team. You get to learn a little bit more, hopefully, with the team that you're working with. And then, you can take that into patient care. With a diverse team, you get to hear a bit more firsthand, what are some of the issues patients face. 

This is very important also, with our LGBTQ community, you want to know, how best can you optimize care to this population? What are some of the things that we can do to make that population feel welcome?

And make the effort to train our staff, so that when a patient comes, they appreciate that. They know what pronouns that they want you to use, and you go ahead and use it. Because that says that you see who they are. And you're recognizing that, you know.

These are things that we may not think about, or we may not know how to approach, unless we have diverse ideas that, bring this to the table and allow us to talk about it, and explore it. And most importantly diverse teams have a creativeness of ideas. And we can certainly see the same thing in medicine. 

Q:   So these goals of inclusivity and strengthening representation, in order to better serve the patient, what are the barriers that you’ve experienced in achieving them?

A:   Change, letting go of what is comfortable, and learning to be uncomfortable. 

And then, I would say the second part is the inertia of uncertainty. You don’t know how to approach this. You think it’s too big to tackle. And so you end up doing nothing. 

If we make the problem too big, if it seems so overwhelming that we can't start with small steps. People get discouraged very early on, and sort of stop working with you on the process.

Q:   And Salewa, you mentioned the “get uncomfortable” sort of mindset a lot. And it’s the mantra for the past year, I feel like, in some ways. So I'm wondering what was it like to be doing the work that you're doing, to be a surgeon on a diversity committee during both COVID-19 and also the Black Lives Matter protests?

A:   In one word, challenging. [laughter] We all saw what was happening. We all heard the news. And it was heart-rending to see. And it’s almost like you see an accident about to happen, and you can't stop it.  

And as COVID spread through the country, those of us who have done health disparities sort of knew that you're going to have communities who are hard hit. And you know the communities who are going to be hard hit. And you know, and so it was hard enough dealing with that. 

And then, to turn on the news and see another episode of flagrant racial injustice, it just added another layer of stress to an already incredible stressful situation. 

And this is where, it helps to have a support team to talk about some of these. But I also thought about it as a call to action as we saw the riots and the protests around the country for us to address some of these issues that have always been there.

I think that they're more visible now because of cell phone cameras. In the world of health disparities, I thought the same thing. We’ve been aware of health disparities for quite a while. We knew when this pandemic was coming up, the communities that were going to be hardest hit. 

As we think about getting vaccines out, we have to become more engaged. It gave me energy to continue doing what we do, because this is work that needs to be done. And if we can do just one little thing to help make that better, it actually helps us feel less powerless, and that we can do something about all what we see around us.

Q:  Thank you so much. Before I let you go, I have a few other questions. What’s the best advice that you’ve ever gotten?

A:   Be flexible. Be able to roll with the punches. 

Q:   Great. What rituals help you have a successful day?

A:   Meditation. For me, that starts off with prayer in the morning. But you have to set aside time to focus, each and every morning, when you start your day, you want to have the clear intention of what it is that you're going to do that day.

Q:   If you weren't a doctor, what would you be?

A:   Oh my Gosh. An opera singer. [laughter] I love Audra McDonald. She’s Broadway. I would probably do something completely different and go into the arts of some kind. 

Q:   Oh, I love that. What advice would you give your younger self?

A:   Take time to enjoy life, because especially in medicine, and in surgery, you sort of draw out Type A personalities. And you're so focused on the next step. And I remember, for me, one of my deployments to Djibouti, Horn of Africa. 

And I remember thinking to myself, at the time, here in Djibouti, when next are you going to come here? Are you ever going to have the opportunity to swim with whale sharks again? Or go whitewater rafting down the Zambezi River? 

And I took a week to go visit Southern Africa. We went to Zambia, Zimbabwe, South Africa. And so take the time to live life, not just let it happen. 

Q:   Do you have any guilty pleasures? 

A:   Oh yes. Dessert is a horribly guilty pleasure. It’s also stress reliever. So at the beginning of the pandemic I was making Victoria sponge cakes and tea cakes. And I gave that up rapidly, because the pounds were coming on way too fast. [laughter] 

But I love baking. There was this show, The Great British Baking Show on PBS. And the pandemic gave me a lot of time to watch the reruns, and try and perfect those creations, to the detriment of my weight. 

Q:   All right. Salewa, thank you so much for being part of this podcast and for sharing your story. 

A:   Kelsey, thank you so much for having me. I hope I answered most of your questions.

Q:   It was perfect.