Episode 2: Healing America
Today, Ken explores national service in healthcare by talking to Dr. Abdul El-Sayed, physician, public health expert, and host of the Crooked Media podcast America Dissected, and Dr. Anne Steptoe, founder of the North Carolina-based service fellowship program MedServe.
The alumni testimonial features Shantell McLaggan, who recently completed her MedServe fellowship at Cherokee Indian Hospital, North Carolina.
Ken Harbaugh: Want to get paid, gain skills, and make a difference in your community? A service year might be just what you’re looking for. Apply today at ServiceYear.org/podcast.
Welcome to Rebuilding America, produced in partnership with New Politics. We’re here to talk about national service: what is it, why do we need it, and can it rebuild America? Today, national service in healthcare.
Today I’m talking first with Dr. Abdul El-Sayed - a physician, public health expert, and host of the Crooked Media podcast America Dissected - about the pandemic, the state of public health in our country, and how national service can help.
We’ll then get a closer look at the possibilities of national service in healthcare by talking to Dr. Anne Steptoe, the founder of MedServe. MedServe is a fellowship program in North Carolina whose mission is two-fold: to assist medically-underserved communities, and to provide fellows with the skills, knowledge, and mentorship needed to carry an ethic of service into their own healthcare careers.
After my conversation with Anne, we’ll hear a testimonial from a recent MedServe alum, Shantell McLaggan. Shantell just completed the fellowship this spring, serving at the Cherokee Indian Hospital in Cherokee, North Carolina.
But first, my conversation with Dr. Abdul El-Sayed. He released a book this March called Healing Politics: A Doctor’s Journey into the Heart of Our Political Epidemic. The book sits at the intersection of public health and politics, diagnosing America with the epidemic of insecurity:
Dr. Abdul El-Sayed: We all pay attention in an epidemic to the characteristics of the pathogen, right? This is the coronavirus pandemic, but if you want to understand an epidemic, it's not enough just to understand the pathogen. You have to also understand the state of the host and the state of the environment. And we are in a moment where our environment has been beating up on hosts for a very long time. And what I diagnose in my book is this idea of an epidemic of insecurity that is driven by the ways that failing systems that have delivered us the basic means of a dignified life in America for a very long time, be they healthcare systems or housing systems or the economic system, or the system of our infrastructure, or even our political system, have been clawed onto by profiteering corporations and to the exclusion of so many of us. And so the experience of being and living and doing in America is an experience of perpetual loss, which leads to a certain insecurity and anxiety. And that is the tinder into which the spark of this virus has landed and explains why in our society we are struggling to tamp down this pandemic, whereas other high income countries across the world have figured out how to do it, have invested in the collective action of doing it and are looking at sending their kids back to school this fall, where we are in this moment where we just keep having these sawtooth increases in transmission that don't seem to have an end in sight.
KH: One of the symptoms of that systemic insecurity you describe is a breakdown of trust. Of course, the oft reported on breakdown of trust between neighbors, the growing tribalism in our society. There's also the breakdown of trust of experts, medical experts in particular. It's a loss of trust that should have never happened in the first place, but how do you regain that with a public that has been so misled and that has really lost its ability to separate fact from fiction in a lot of cases?
AES: Yeah. I mean, that really is a critical, important question. On the one hand, it is the consequence of an inequality in our country that has left a lot of people behind. And when people feel like the systems of knowledge and understanding have disinvested in them, they tend to disinvest in those systems. And that is in some ways the fault of the science community itself, but also part of what happens-
KH: Speak to that. I normally don't hear scientists themselves assuming any responsibility for that loss of faith. I'm intrigued.
AES: Yeah. Well, I mean, number one, we've disinvested in public education in ways that leave people misunderstanding how science works in the first place. Science isn't a set of opinions. It's not even a book of knowledge. It's a process by which we ask and answer basic questions. And the frustration that I've often had with my own science community is that we're not good at going back to the public and explaining what we found and why it matters. And we assume that the proof's in the pudding, but that's just not the case. And so, because we have in so many ways as a community separated ourselves from the rest of society, arguing that if you don't understand the work that we're doing, well then it's on you, not on us to explain it, I think is part of the problem. And we've forgotten that so much of the best science is publicly funded. Meaning we, as scientists need to be able to have a consistent interchange with the community and say, "Look, you paid for this research. Let us show you why it matters and let's make sure you understand it." And that kind of public communication and public investment, I think, is missing. So I just think that the system itself has collapsed and it has collapsed in some respects because those of us who believe in science and believe in all that it's delivered for us, have failed to explain that and to continue to have the humility to communicate that to people who don't necessarily spend their days doing what we do.
KH: It's very interesting me that you talked about the importance of communicating with the public. Later in this series, we'll be airing an interview with David Isay, the founder of StoryCorps, who talks about the power of story. And I've often made this observation that in our current political climate, stories are all that we have left to make the case. Facts don't win arguments anymore by themselves. You have to embed them in a compelling narrative, in a story. I would submit that that might be something the scientific community needs to be better at telling a compelling story that of course incorporates the right facts, but doesn't just present charts and diagrams.
AES: Absolutely. And when I talk to young scientists in particular, I always remind them that they spent a lot of time in education learning how to think empirically and how to take the bias out of their thinking. You're being taught to think differently than the average person thinks. And where we fail is to think that somehow this system of thinking is normative. The story I always tell is go back into some fictitious small tribal community a thousand years ago. And you can imagine a woman and her child and a well. And that child was playing awfully close to the well. And she's got two options about how to warn her child about what might happen. Option one is, "Dear child, I don't know if you read the most recent journal, but in that journal article they showed that there was a statistically significantly higher chance of falling into the well and grievous bodily harm if children were to approach that well within seven feet," or the other way of thinking about it is, "Hey, child, do you remember Charlie?" And the kid says, "Yeah, of course." And the mother says, "Yeah, look, Charlie was doing exactly what it is that you're doing right now. And you haven't seen Charlie in a while, have you? So next time you see Charlie in the bottom of that well, you tell him, I said, 'Hello.'" And there's a way of communicating the story about what we find that I think is so critical. And so evidence always has to be held high because, of course, it is the most elemental aspect of truth that we have, but evidence tells us what to do. It doesn't necessarily tell us how to do it. And so the point that I'm making is that stories and emotions have to be the motive force behind being able to communicate the direction that the evidence tells us we need to go. I wish that we were a little bit better and a little bit more humble about recognizing that empirical reasoning is something that so many of us in science spent a long time learning how to do, but it's not the way that people have been communicating with each other since the beginning of humanity. And we've got to be a lot better at telling our stories because each of us became a scientist because at one point we found the wonder of science just incredible. Tell that story and I think you'll find that so many more people want to listen.
KH: The messenger also matters a great deal as well, especially as we're trying to spread these stories into communities that haven't been receptive before. And this brings me to the idea of civic responsibility and community responsibility and where national service might be able to play a role. How can we leverage the incredible wisdom held within communities and direct it towards service within those communities, especially in light of COVID-19 and the tremendous work that's going to need to be done over the coming months and probably years? It seems like we're going to need tracing corps and just armies of young people helping those in need. We're going to need all kinds of human capital brought to bear on the recovery and we need to do it together.
AES: I think that's absolutely right. And what I'll tell you on that front is, when I had the privilege of serving the city of Detroit as health director, one of the most important realizations I made was that all of the answers that the community needed were right there. And my job was to be able to facilitate the conversation between the public and the public service so that we could deliver those answers into results for real people. And I think that there is something beautiful about our democratic republic in so far as we believe in self-determinism in government, that we have this government of the people, by the people and for the people. And at core there is the people. And unfortunately sometimes, we haven't been as great at centering the people we want to serve and making sure that we're building our service institutions with empathy toward those folks and centered around those folks that that government is intended to serve and it's also invested in by. And so COVID-19 is going to have ramifications that we're just starting to appreciate. The ripples of this thing are going to extend for decades. And I hope that this is a moment where, as we are contending with this pandemic, we are recognizing how much we miss each other and how central people are in the dynamics of a dignified life. And we're also rethinking all of the ways that our institutions need to center people who we need to serve. And if we get this right, it's going to be because A, government is empowered to do the work we uniquely can do. And we shake the ways that large corporations have dominated so many of the public services that are now missing in action. But also because we rethink those public services around the people they're intended to serve in a way that justifies and demonstrates their value implicitly. And I think if we do this right, we can not only come out of this, but we can prevent anything like this from happening again.
KH: As you well know, there is a surge in interest and enthusiasm for the idea of national service coming from young people in particular, but you see that reflected in legislation making its way through Congress now. How important do you think it is that if indeed we do see a dramatic expansion of national service opportunities with a focus on public health and maybe even the creation of a dedicated public health corp, that we populate those efforts with people from the communities being served?
AES: Yeah, no, that's absolutely right. And I think that ethos of public service is critical to get right, but you're right. It's almost impossible to drop in on a community that you don't come from and whose experiences you don't share and assume that somehow you're going to be able to deliver that kind of people-centered service. And so when we think about representative government and representative service, it's essential that we are empowering people to serve one another in their own communities and that people see themselves in that edifice of public service. I think sometimes we put obstacles in the way of empowering people to be a part of this thing. And my hope is that in the next iterations of a public health service corp or a service corp to end and fight climate change, that we are making a real investment in growing the pipeline right into local communities for folks to be able to step up and serve one another, to serve their neighbors. And to be that aspect of representative government, that is so hallowed in the ideals of our country but so often the mark is missed.
KH: You've already begun answering my next question, which is an invitation to think big and think 10 years out into the future. Say, we have a vaccine for COVID-19. We've beaten it. What could national service do for us 10 years down the road? Is this just a tool for the moment or is it bigger than that? Is there something that national service can do for the ethos of the country beyond COVID-19?
AES: I mean, I think it has to go beyond COVID-19 and as we started the conversation, this epidemic is bigger than one virus. It is about the way that our society has failed to serve people in some profound way. It's not just that we have a virus that is floating amongst us and has killed thousands of people in our country and taken away the livelihoods of thousands more. But it's also the fact that we have struggled at baseline with housing insecurity and lack of access to healthcare and broken crumbling infrastructure and a political system that people don't feel like is worth their time investing in. The deep and abiding pestilence of racism. And national service is an opportunity for us to reinvest in each other and to take on the epidemic of insecurity that I think has laid the groundwork for this particular pandemic. And so this is about not just a momentary technical intervention to provide hands to take on this particular challenge. But it's about reinvesting in collective action and in one another and in reminding us that we are one another's greatest asset and if any of us are suffering, all of us ought to be suffering with them. And so we've got to be invested in a kind of society where no one is left behind, nobody is vulnerable, nobody is insecure so that all of us can truly thrive.
Dr. El-Sayed asked us to look beyond the tragedy of this pandemic when we think about national service and investing in the health of our communities. My next guest, Dr. Anne Steptoe, is an incredible example of this work.
We’ll hear from her soon, but first let’s take a minute to learn about New Politics, the sponsor of this podcast. Stay with us as founder and Executive Director Emily Cherniack tells us about the work New Politics does to lift up servant leaders into elected office.
Emily Cherniack: New Politics, which is an organization that I founded and now run, we are a nonpartisan organization that aims to revitalize American democracy by recruiting, developing, and electing servant leaders who put community and country first. We help these outstanding leaders who have served in the military, or national service programs like AmeriCorps or the Peace Corps, run for office because we believe leaders who have dedicated their lives to serving our country are the kinds of proven leaders we need in politics. We think that leadership should transcend "party". So we'll talk to, and consider, supporting anyone who has served and embodies those servant leadership values.
I would say to anyone who feels disillusioned and hopeless about our politics to not lose hope, because there are a wave of leaders coming up through the pipeline who have what it takes to change our politics. These are amazing servant leaders from across the country who are stepping up and answering the call to serve again, and as candidates and campaign staffers and volunteers. Leaders like James Talarico who is a Teach For America alum and in Texas was the youngest state rep to be elected and he has already done some big wins with bipartisan efforts on education reform. Or you look at David Crowley who is a Public Allies alum and Milwaukee state rep who, after scoring big wins for his community, is already positioned to even make more meaningful change as the first African American elected to the County Executive in the history of Milwaukee. They embody what it means to put the country first and they are sort of the hope and the inspiration that I feel when I think about the future of our politics for America.
KH: If you’re thinking about getting involved in politics, visit newpolitics.org to learn more about taking the next step in your service career.
My next guest, Dr. Anne Steptoe, has successfully adapted the national service model to healthcare through her organization MedServe. Some have called MedServe the ‘Teach for America for medicine’.
Dr. Anne Steptoe: I think what we really share most with Teach for America is a desire to address a workforce crisis. If you think about the Teach for America model of plugging recent college graduates in as teachers, as educators, kind of full educators in the classroom, we don't do that. We don't send out recent college graduates to become doctors in communities that need it. But we are interested in fostering the next generation of people to do that work, and so that's why we use the analogy. We want to remind all of our stakeholders that we're not just providing connections or opportunities between organizations and young people, but we're doing so very intentionally with the hope that the young people who participate will be inspired and transformed by the experiences that they have and set on a trajectory of a service career through medicine.
KH: That's an interesting nuance because the fellowship isn't just about serving those medically underserved communities. It's about what it's going to deliver to the participant, which is not a typical theory of change for a service organization which is usually focused on the recipient and not the deliverer. How did you come to that framing of your mission?
AS: It certainly makes us a more complicated organization in that way, in that we have two constituencies that we serve. Their needs don't always perfectly align, and we spend a lot of our time trying to thoughtfully balance those needs. But I think that we came to that decision because we saw a really powerful alignment between those needs that wasn't being captured. We saw really wonderful organizations making pretty powerful change in their communities that weren't being talked about in large cities or university communities, and that young people weren't hearing about as role model organizations that could be formative to them early in their career. And at the same time, those organizations were struggling to recruit and maintain enough human capital to really maximize the impact of the work that they were doing. And so I think it works for our organization because there is that really powerful synergy between them.
KH: I definitely want to talk about that synergy, about maximizing impact. But let's get a bit of the backstory first because I'm very interested in how you personally came to this. What sparked your interest, not just in medicine, but in creating the kind of program that is going to expand opportunities for many, many young people to get involved in the medical field?
AS: Well, I think the answers to those two questions are really closely linked because I am a user of the problem that I try every day through MedServe to solve. I grew up in a small rural community in West Virginia, and so for me the shortage of primary care providers and healthcare providers in rural and other underserved communities is part of the fabric of my life growing up and is something that, just from being in that environment, it's hard not to see that through a very personal lens of how it impacts family and friends. And so my first draw to medicine was really spending time in that community and then coming back with a little bit more education as a college student and wanting to be involved in public service in my community and really seeing this powerful area of healthcare where we talk about and are engaged in really big ideas about how health is a human right, and how to deliver that on very large scales. And we're also really engaged with the person right in front of us and how we can make them feel better that day. So I was really drawn to that. And I was particularly drawn to it in the family practice setting in my hometown, where I felt like small scrappy organizations and really dedicated physicians, public servants were all around me, and were energized and had really innovative ideas. And so it wasn't just the delivery of healthcare. It was the delivery of healthcare in that particular context that got me excited. And then I got closer and closer to actually going to medical school, and I took the MCAT standardized tests. I took organic chemistry, which no one should ever have to do. And none of that felt at all related to that wonderful scrappy world of providers that I had met that had inspired me. And that was really the start of MedServe, was how could I have had the opportunity to spend more time in that kind of nurturing setting that I think for the right person is energizing and is also just a good place to put your two hands to use? And why was it so hard for me to get that experience? Because in retrospect, I was very lucky that I just happened to like to go home frequently.
KH: How has the response been among young people seeking to participate? Has there been an influx of applicants?
AS: I continue to be really impressed. We're still a fairly young program. We sent our first cohort out in the summer of 2016, and I remember being shocked and humbled that anyone wanted to entrust two years of their lives to us in our program. That year and almost every subsequent year, we've ended up with somewhere between a 10 and 20% acceptance rate. So I was just floored by the number of people that responded to that message, and that were willing to dedicate a pretty significant time of two years to engaging in that work with us.
KH: How far afield do you draw your fellows from? I mean, do they find themselves in situations where a kid from So Cal is serving alongside one from the holler in West Virginia?
AS: There is some of that, because I think that one of the things that I've learned that I've found so energizing in this work is that there is a type of service for everyone. And we've been really excited as an organization think about, within our mission, what can we do to provide a diversity of service opportunities so that we can get as many people as possible excited about service? And also kind of match the very unique needs that different communities and different clinics have to a huge diversity of human beings? And so we do have fellows who come from all over the country. I would say that a majority of our program each year has some tie to North Carolina because we do see that background knowledge is an asset in what is a really hard learning curve of service. We have been particularly impressed by the way that fellows from very different backgrounds have engaged with each other, and learned a little bit about what the young person from So Cal has to teach the person from the holler in West Virginia. And vice versa.
KH: I want to dwell on the subject of learning and the learning curve that goes with service a little longer, and I'm channeling conversations we've had with Teach for America members and leaders who are careful to emphasize that their fellows aren't just going into schools and teaching. They are there to learn, and the communities in which they serve have a tremendous amount to teach them, to teach the teachers. What have you seen along those lines in terms of your fellows learning from the communities that they serve?
AS: It is so true and we try to sort of structurally emphasize that by asking each clinic to identify mentors who are individuals that we think fellows are particularly likely to learn from. And I think in some ways it's a little bit easier for our fellows to see that learning process. One, because healthcare is inherently new to many of them and scary. And so there's a little bit of reverence built in, and because healthcare is a team sport. So our fellows often go in in helping or assisting positions where they are not the quarterbacks of the team. So I think it's easy for them to see that learning. And we try to emphasize it through the presence of mentors. I think what we learned actually early on was how artificial that was. Because we could identify a really rock star physician who we were excited for people to learn from, but actually we should have listed the nurse manager who has been working in public health for 40 years. Or the community health worker that has built a migrant farm worker health program from the ground. There are just so many of those potential learning sources that we do a lot of training with our fellows now to remind them that mentors are everywhere to be sought out when you work in a team context like healthcare.
KH: Where do you see the fellowship in five or 10 years? And I don't ask this as a pure hypothetical. I'm asking it in the context of this surge of interest in national service, in the context of these bills that are working their way through Congress that finally seem to have a real possibility of passing. If there were a multibillion dollar investment in national service, how could something like the MedServe Fellowship, which is really tough, in many ways it's not your typical national service in that the skills requirement is very high. It's incredibly selective. With all of that in mind how do you see scaling the fellowship, especially in light of our current healthcare crises?
AS: I think what we have always seen in the MedServe model is how ripe our market is for scaling. If you had told me that we would be a federal fund recipient about two and a half years into our existence, or that we would have increased our membership in North Carolina five-fold in our first four years of existence, I probably would have told myself that that was crazy. But we really push ourselves to do it each year because we see that demand, both from clinics and their communities and from fellows. And I think that everything that is going on right now with COVID-19 has really shone a spotlight on healthcare and opportunities for service in healthcare. We are an oddball service program for so many reasons. But one of them is that there are not many service programs looking across the country that engage young people in healthcare. I think there are a lot of assumptions that have been historically made about young people's interest in participating in that, in clinics' interest in participating in that. Healthcare, after all, we're the industry that still uses 1980s pagers. We are slow to move. But I think that what we see is that when you actually go out into universities and you actually go out into communities and talk to clinic leadership, that's not the case, and there is a ton of interest. And what we see is that when we place one MedServe fellow, next year the clinic is asking for two. We place two, the next year they're asking for four. And so I do think that there's a lot of capacity for us to grow. We always want to be thoughtful about what that means. I think that we take a lot of pride in the experience being high quality and not just being a matchmaker who then is just matching bodies to needs. We try to be a lot more thoughtful about who we're bringing into the program, their skillset, their background, and what clinics we're placing at and what they have to offer and whether MedServe is really the right solution to meet their community needs. So I think that looking five years from now, I see that same kind of swell of demand here in North Carolina that we have seen, where as our partners come to know and trust us, interest grows. And so those clinics will ask for more fellows the next year. And they'll tell the clinic down the road who will be interested in having a fellow as well. But what really interests me is we see such a national interest in our program among fellow applicants and as someone from a state that is incredibly medically underserved that is not North Carolina, I know that the experience of serving to build skills, to be a physician in West Virginia, for example, is different if you have a service experience in North Carolina. So I talked a little bit earlier about that there's a service experience for everyone and wanting that to be tailored and to show the diversity of opportunity that's available and match that with a diverse candidate pool. And I think that at some point a question our organization has to answer is ‘can we fully achieve that mission if we only operate in North Carolina?’ I think that that's a question that as an organization, we're kind of rapidly approaching.
KH: The hopes that Anne has for her fellows - that they learn from the communities they serve and are inspired to continue in healthcare and in service - all came true in Shantell McLaggan’s experience. After graduating from UNC Chapel Hill in 2017 and finishing her pre-med requirements before applying to medical school, she saw an email about MedServe in her inbox. It was exactly what she had been looking for.
Shantell McLaggan: Basically my whole life, I've always been really big about service. I want to go into medicine to touch the most vulnerable populations of individuals and make a huge difference in their life and I've always said to myself, "I really wish that there was a program where I could go work in a community and immerse myself in that community and be able to serve people, be able to enhance my clinical and healthcare knowledge and skills while also having just a really wonderful experience.”
You get to serve in a community for two years and MedServe has its arms all over North Carolina. For example, I was in Cherokee, North Carolina, which is way out west. It's like 15-ish minutes from Tennessee, so it's really, really out there in North Carolina. I served for two years there and just got, just a whole bunch of knowledge on the ins and outs of healthcare in terms of patient relationships, how to be a good provider, as well as just how the system works, so it was just all-inclusive, and at the same time, I was able to immerse myself in a community that I was not very familiar with prior to doing this. I'm from the Triad region, which is about four hours from Cherokee and I never really had a reason to go out there, so it was a really cool way for me to learn more about a different culture as well.
My time in MedServe has impacted me as both a person and a professional in so many different ways. Starting from day one, the day I moved out there, I started growing as a person. I had to advocate for myself and learn how to navigate this brand new facility and figure out what I was going to do for the next two years, so that gave me a lot of mental maturity, I think. I've also learned how to communicate with a very wide range of people professionally. I have learned how to lead meetings, how to lead projects, and those are skills that I think that I'll take with me for the rest of my life. I've also, I think, become more emotionally intelligent. I've always liked to consider myself as someone who had a good grip on their emotions and was able to, I guess, support people however they needed it emotionally, but being in Cherokee and having the roles that I've had and the conversations that I've had with different people over the last two years I feel like has allowed me to develop that even further. Just having the experience in MedServe, it's given me more of a hands-on, I guess, idea of what the day-to-day life of a primary care doctor in the various fields, what they do and what their day looks like, and it's just made me even more excited to be a primary care doctor.
KH: Next week on Rebuilding America, we’ll dive into that organization people compared MedServe to: Teach for America. We’re talking about national service in education, and you’ll hear my conversations with Rey Saldana, CEO of the non-profit Communities in Schools, and Elisa Villanueva Beard, the CEO of Teach for America itself, about how each of their organizations is using service to improve education for students across the country.
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Rebuilding America is a production of Evergreen Podcasts, made in partnership with New Politics. Our producer is Isabel Robertson. Associate producer is Leon Pescador. Audio engineer is Sean Rule-Hoffman. Special thanks to Evergreen executive producers Joan Andrews, Michael DeAloia, and David Moss.
I’m Ken Harbaugh and this is Rebuilding America, a podcast about national service.