Improving Health in Resource Poor Settings on the Local and Global Levels

My name is Brian Swann. That’s my name, but not necessarily who I am. I am from the United States of America, born in Tennessee, raised in California, and now residing in the Greater Boston area. I’ve been here for the last eight and a half years.

My current role, in terms of career, is that I am the Chief of Oral Health for the Cambridge Health Alliance, Oral Health Department. The Cambridge Health Alliance is the largest safety net organization for health care in the state of Massachusetts. I’m also on the faculty of Harvard School of Dental Medicine and the faculty of Harvard Medical School, teaching, mentoring, and lecturing. I am in the process of seeking to rise to the promotion or status of Assistant Professor. That’s ongoing currently.

My other role is that I’m a father of six daughters. I won’t give you their ages, but I will just say that they are all grown women. I am also a grandfather of eight grandchildren; one is with me today. I’m also a great grandfather of one little great granddaughter. I have those roles to play as well.

I’m also very involved in the Global Surge that has been made at the Harvard School of Dental Medicine as part of the dean’s committee on global oral health. I help to work on projects in Haiti, Rwanda, and the Wampanoag Native American community on Martha’s Vineyard.

It has to do with a couple of things. One of them is to build capacity in resource-poor settings. In other words, I’d like to look at ways and methods to take the current resources that one might have on hand and how to build capacity with just what we have. That could be in terms of educating people, cross-training people, and coming up with methodology where you can get more bang for your buck or, in other words, how one community health centre can see more patients with the same amount of staff, same amount of time, and same amount of space. We look at models that will lend themselves to some of those types of issues.

I’m also currently working on doing those same kinds of things on an international basis, and one of the components of all of this work has to do with expanding the capacity within our field. I’m also working on how to impact the shortage of primary care provision globally. I believe that oral health care providers are a pivotal and untapped resource of people who would be able to actually address that problem if we expanded our scope of practice. That is, to include primary care in the scope of oral health and also for primary care to include oral health in their scope of practice.

This problem is important because oftentimes, people believe that they need to have much more material, many more people, and greater resources before they can act. I believe that you have to act with what you have to prove to yourself that you can make a difference, and you can build on that. Not only does that benefit you individually or as a group; as you build on that, you grow, but your community that you’re serving grows, and the people who are watching from the outside would be more apt to contribute to that growth when they see that you’re willing to work yourself. We are globally developing a mentality of consumers who are waiting for someone to do something for them. We have begun to lose our tenacity and our fortitude to be able to do for ourselves. I’ve seen that happening all over the world, including here in America, where everybody has a handout, instead of just deciding that you’re going to take charge and make something happen.

One good example of that were the women in South Africa. They were tired of waiting for the men to build a home, to start a business, or to support a family; they were all just tired, and the women decided to form their own clubs and organizations and began building their own homes. They started their own businesses because they’d just got tired of waiting for someone else to give it to them. And we’re the ones we’ve been waiting for. I’ve used that phrase, a Native American proverb: “We’re the ones we’ve been waiting for.” We cannot wait for anyone else to do it for us. Otherwise, it may never get done. If we are looking at generations, it is those generations who are going to watch us the same way we watched our elders, our grandparents, and our parents. That was our example to move the agenda forward. That’s what we have to continue to do.

It’s important from several ways. It saves lives by introducing health care to places where they may be resource-poor. It also motivates people and demonstrates that you can make a difference in your life and in the lives of the people that you can affect.

I think you address the problem in going back to some of the training that you get in the School of Public Health. You address the problem by, first of all, deciding to take ownership of the problem in terms of making it something that you either are naturally or can become passionate about, and that passion does give you a lot more energy. You have to involve the stakeholders and the community of those people that are in the facility of the area that you want to address. You have to look at collaborations. No longer can you do everything by yourself, so you look for collaborations, and you look for those collaborations from the stakeholders. You may look for those collaborations with people who have a similar interest. Then, you begin to outline first steps, and oftentimes, you have to start with a pilot program in order to be able to believe that you can make a difference and to demonstrate to others that you can make a difference. That is getting the momentum going.

However, you have to be able to start. Getting started is oftentimes the hardest part. A lot of people are quite intellectual, but their intellectualism often gets them nowhere. They become stagnant because they are constantly discussing the issue and never making a move. You don’t know what you have and what you don’t have until you actually begin. That’s the way I begin to address problems: just begin and try to motivate people because I’m passionate about the things that I’m working on.

I think that, first of all, you have to look at your natural gifts. Your natural gifts are the things that just drive you and you just feel good about doing. Some people know what those gifts are, but sometimes, people don’t. There are spiritual gifts tests that you can actually take to show you if you have the spirit or the natural gift of compassion or service. Maybe you’re a visionary. Maybe you’re just a doer.

When I came to Harvard, one of my mentors, Dr. Chester Douglass, came to me one day and said, “I know what you are.” I said, “What?” and he said, “You’re a doer. You need to do what you’re talking about.” I used to get in trouble because I would start doing stuff, and they would call me in to the Chair’s Office and say, “Hey, you can’t just do that. There’s a protocol that you have to go through before you can do that.” I would say, “Oh, I didn’t know,” because my normal reaction would be to just get started. However, it does require that you develop skills that will help you analyze a situation so that you are not going to waste resources and time—and time is a resource, and so are energy and money and things like that.

Many people have to also understand that if you’re going to create teams, everybody is not thinking on the same level. There are some people who really need everything laid out. They cannot move until you have defined goals, aims, principles, and methodology. They need to see all of that. Does it mean that they should be excluded? No. Your team needs to be made up of all kinds and varieties of people who will think in different ways because bringing those things to the table and finding a way to harness that energy is a skill in itself. You do need some leadership skills in order to be able to motivate people, to keep them on board, to just keep them engaged, and to be able to see—if they can’t see on their own—that you actually are making progress.

In Rwanda, a lot of doctors have come there with HRH project, and they have been extremely frustrated because they did not achieve the results what they had preset in their minds before they left. But they had no idea where they were really going. They had no idea about the cultural competence or the learning curves or what people’s education levels really were compared to where they came from. They had to reset themselves to be able to understand that there are rewards of any program, but you may have to measure them differently, and the scale may have to be tweaked such that you’re measuring a little bit less or maybe a lot less than what you thought.

But then, you have to also realize that there is perspective, and what’s relevant to you is different somewhere else, so you may have to change in order to adapt to that. In order to know that, you have to dig a little deeper. These things are not always on the surface; you need good leader skills and good visionary skills, being able to understand and take the time and make the effort to understand what problems you are dealing with, as well as learning that you have to research issues because there’s information out there that will save you a lot of time if you take the time to find out what other people have done in a similar situation. It may not be the exact thing, but it may be something that will give you some vital information when you’ve done that. I think that most people who want to work together in a collaborative effort want to know what else has been done. Don’t start with the fact that you don’t know. Do your due diligence and find out what has been done so you can bring that to the table as well.

The best degree I’ve ever gotten is a master’s in public health besides, maybe, high school. The master’s in public health is a degree that I recommend for anybody doing the kind of work that I’m doing because you get a chance to see models that you are not going to get in your discipline necessarily unless it’s public health. However, in going to a school of dentistry or a school of medicine, everybody’s still doing stuff in silos. They’re trying to move beyond that, but it’s a really slow process. Some of the newer models of training institutions might be doing it a little bit better; I don’t know. But in the conventional programs, they’re still educating people in silos, and they’re getting out and have the same theories oftentimes as the people who graduated 75 years before they did. That needs to stop. That needs to change. We’re hurting ourselves by not coming up with creative ways to educate people so that they do become people who are looking at these methodologies to solve issues and problems. We’re not training them that way.

We don’t have that much time because I’m not a spring chicken. I’ve been around for a long time, and I can truthfully say that when you turn fifty years old, which I am way past, you have been around the block one time. That’s a really remarkable time, to turn fifty, because you see things differently. You have things revealed to you. Family secrets come out of the woodwork. There’s this whole bunch of stuff that happens when you have reached at least a half century. It’s a remarkable and enlightened time of your life.

To get to this point where I am today, it took a lot of tenacity. I was raised by grandparents. I knew all of my grandparents, for the most part. I knew my great-grandparents, and I even got a chance to meet a great-great-grandparent. I don’t remember them too much, but I do remember them. All of that contributed.

I also grew up in a small, rural, southern town and then moved to a small town in California that had very tight, close-knit communities where the people who were raising us raised you as if you were their children. We were raised in that village setting, so you not only had good role models around you but also had to learn to be accountable for what you did or what you didn’t do because there was always somebody watching your behind. And you would be in trouble if you did not do what was right. That kept you sort of on a path, and that path is so important to be on because you don’t have all the answers, but you’ll get them. They come. You often go to these same people and ask them for advice. They don’t really give you a whole lot of details because they know that you’re going to find those things out, and they can’t fix your life for you, but they do encourage you.

We grew up in the church, as well, and the church was a place that was supportive. It was less judgmental than everyday society. It was a refuge where you could come, and even though you may not have been as talented as someone else, everybody still congratulated you. You had an opportunity to perform. You had an opportunity to give a speech. You had an opportunity to sing in public. You had an opportunity to read in public. These, you didn’t know, were crucial lessons that were preparing you for the next steps—and it is just to the next step.

I also got a fairly good education in elementary school even though I am part of the segregated South. I was also part of the Civil Rights Act, so I was part of the cohort of African American students who integrated colleges, high schools, and graduate schools. I was in that whole era of the Black Movement, this renaissance that took place in the sixties and seventies here in America. It was a powerful time. It was a time of people really checking into who they are and their culture and wanting to embrace that. It was a time when people actually came closer together because they were supportive of this movement. That also crossed racial barriers because it was a time when people were thinking about peace and freedom, and that didn’t have just a color to it. Everyone who felt that joined in the march, and so did I, and I integrated in these schools. I ran across a lot of biases in graduate school, in undergrad, in high school, and in elementary school, without my parents having the wherewithal to actually come to the schools and to be supportive of whatever the truth was. Those things taught me also that you need to speak up for yourself. If you are wrong about something, then you need to be able to speak up and say “I apologize” and “I’m sorry. Forgive me.” If you’re right about something, then you need to be able to stand and make a stand, and not just succumb to whatever someone else was trying to get you to say or do. That’s how I made it through, and it still continues today.

After thirty years of practicing oral health and going against the grain and working in underserved communities, both in the public and private sectors, I decided that the walls of my practice were no longer big enough to contain me. I also dreamed one night about fixing people’s oral health without necessarily charging them or marketing to them, which is what you do in the private sector because you’re running a business. It was so refreshing to have that dream that I decided at that point, with the advice of a few other colleagues that I should go back to school and get an MPH. That’s what brought me to Harvard, and I’m glad it did because it was a reinventing of myself. I was getting stale and crusty, and I wasn’t thinking as clearly. I wasn’t engaged in the policy, in advocacy for the things that I believe in, and that sent me on another course, but it was the culmination because I don’t believe anything is wasted. Everything has something about it that can be good, that is useful. This sort of amalgamated those experiences that I’ve had along the way. To come here and actually produce products that you can actually give to other people globally is one of the best things I could ever imagine.

I had dreamed in graduate school that I would have a consultant firm that would go to various countries of the world, research their problems, go to their ministry of health, education, prime minister, president, dictator—whoever—and say, “We can eradicate this problem in this amount of time at this cost.” Then, I worked on teams of professionals across the board in order to do that. Well, I don’t have a consultant firm, but I am part of the team that’s actually doing this kind of work now. It is not easy, but it is good work.

I would go back to my parents and other relatives. They always inspired me, as well as the community around me. They always inspired me. Within my community, I always felt great, but outside of my community, I didn’t. Outside of my community, I competed to try to be on top. Sometimes, I failed; sometimes not. But I never felt completely accepted outside of my community. I never felt really secure outside of my community. And the way I grew up, you needed to have a good front. In other words, as a young man growing up in the communities where I’m from, or the communities that I’ve visited, such as south side Chicago, Detroit, and Knoxville, Tennessee, and all those places, you needed to have a good front. In other words, you had to know how to carry yourself to make people believe that you were not afraid. Otherwise, they would take advantage of you, they’d beat you up, or they’d rob you. I could carry myself, but I didn’t always feel secure outside of my community. The people who reinforced me were the people in my community.

When I left the communities that I grew up in, I had to figure it out. I had to rely on those reinforcements, and I had to often return to the communities that I’m from to get reinforced more before going back out there in the “world,” where it was dog-eat-dog or people were putting you down because of your physical appearance, or what community you were from, or what school you did or did not go to—all those cliches that really don’t amount to much. But we all have egos; we’re all pretty fragile inside, and those things do hurt our feelings. You learn to fight back in the best way that you can, but you’re also battling with yourself in order to try to reach a point where you are secure in who you are. It’s okay not to know everything. It’s okay to have made some mistakes in life. It’s okay to forgive those people who have wronged you, and it is also quite okay to forgive yourself in order to continue to move forward along that path.

Currently, I work for the Cambridge Health Alliance. That is a safety net organization that works primarily with a population of people on the other side of the Charles River, so basically Cambridge, Malden, and Everett. We have three hospitals, which are the Whidden Hospital, the Somerville Hospital, and the Cambridge Hospital. We have approximately twelve clinical sites, all of which are hospital-based. Unfortunately, there’s only one dental site now. There were three; now there’s one, and that site is in Cambridge. We’re the only public health entity for oral health within the Cambridge Health Alliance, which has a catchment area of hundreds of thousands of people. I can’t tell you exactly how many, but I think it’s close to half a million people in the catchment area.

The Cambridge Health Alliance is also unique because Cambridge is, I believe, one of two cities in America where a safety net organization’s CEO is the head of health care in that city. The manager or director or commissioner of public health for the city of Cambridge reports to the CEO of the Cambridge Health Alliance. The Cambridge Health Alliance is the public entity for the city of Cambridge. It’s a unique model, in that respect. I’ve been there for approximately six years. We have a general practice residency program for a general dentist who’s affiliated with Harvard. We also do a lot of training. We are a hospital-based dental clinic. We have to go through a joint commission, the same way a hospital would do. We train dental assistants. We train dental hygienists. We rotate and do externships through our clinic. We also have medical students who come and visit our clinics as often as possible to show them what we do. Then we have geriatric fellows who also work at our sites, serving a very large elderly service program.

I do a little bit of everything that I could possibly want to do and, sometimes, more than I would really like to do because it is very time-consuming. But every day, with the exception maybe of one per week, I treat patients, unlike a lot of chiefs in departments; they may not treat patients as much as I do. I do treat patients because we have a relatively small clinic. We have seven operatories or seven rooms with dental chairs, and we treat more than 12,000 encounters per year. If you look at that, in terms of other community clinics or hospital-based clinics that are our size, you won’t find many of them who will see more than that per annum.

I treat patients every day. I supervise as an attending general practice resident every day. I work on projects every day. Those projects are with grant writing, with a team with the Wampanoag Project, which is a native American group that’s in Martha’s Vineyard that we have an outreach program affiliated with Harvard Dental School. I work on presentations every day, where I have become a national speaker in terms of the work that I do. I work on the group model, which is another intervention that I help to design, where we are working to build capacity by working on certain types of dental patients in groups rather than individually, which increases access for us and for the patients.

I teach in the school of dentistry and also with the school of medicine in a course called “Patient-Doctor 1.” I mentor and advise students on a regular basis, which comes every day. I receive phone calls from colleagues both internationally and locally on a daily basis. I receive at least forty to fifty emails every day, and I try to answer most of them. I also receive several phone calls a day from either my grandchildren or my children with issues that they may be dealing with or questions or things like that.

My days are full. I normally, on average, go to bed each night at 1 o’clock in the morning. That’s my typical day.

I create value by being an oral health care provider and constantly advocating for oral health. That oral disease is a risk factor for non-communicable diseases. That equation should be put into all of our primary care systems. By doing that, we would lessen the burden of disease. We would have an impact on patients suffering from non-communicable diseases, especially oral disease, and be able to reduce health care cost and improve health care.

I increase value by being the most productive member of our clinical team. I produce more than any of the other clinicians, and that’s basically because of the style in which I work that grew out of twenty-five years in the private sector. When you’re working in the private sector, you don’t do one filling at a time. You do quadrants at a time whenever possible, so your productivity is much higher.

I think that I’ve brought value to the Cambridge Health Alliance by increasing the visibility of oral health within the alliance. We still have waves to go, but we’re working with medical students or sending GPR residents to all areas that we think would be impactful to educate them about the value of oral health and how it relates to other systemic diseases. That can be in the Emergency Department; rotations in the homeless shelters; rotations that we’re also affiliated with through the alliance; rotations through the Ear, Nose, and Throat Department; creating slide presentations for the patients who are going to have osteopathic surgery or joint replacements and need to know what dental diseases need to be rectified before they have this type of work done; or cardiovascular kinds of issues. We become this resource, and as we are working diligently to integrate more succinctly, we’re trying to make sure that people don’t forget that oral health should also be part of the medical home. We are often left out of that. It goes back to how our physicians have been undereducated relative to oral health.

Indirectly, I work a lot on trying to change the curriculum that would have an indirect effect on my organization by bringing future health care providers to the training programs through our dental clinics so that they’ll understand a little bit more than what the would normally have about the value of oral health.

I collaborate with my staff. Fortunately, over the last few years, they have given oral health an administrative director. I have on my staff an administrative director, a clinical director, and (sort of) a regional director. We work together in solving issues, and it’s nice to be a part of that team because there are a lot of issues I would never be able to address because I don’t have time and/or because I may not be the person most suited to address some of the administrative issues. That work together with a team of people who are doing due diligence to investigate and come up with ideas that we can discuss collaboratively is refreshing for me. I really need to have a personal assistant who would help me keep up with the various places that I go to do the stuff that I do. But I enjoy working with that staff team.

I also collaborate outside of the Cambridge Health organization on the projects that I work on. I worked in Rwanda for six months last year, from February to August. That was a collaboration between our government and their government. It was a collaboration between the Harvard School of Dental Medicine and the University of Maryland’s dental school. There are also collaborations that I work on with the Wampanoag projects, collaborations between the Harvard School of Dental Medicine and Partners Hospital and Martha’s Vineyard Hospital and an agreement with the Wampanoag community themselves. I work with a lot of different collaborations. The work we’re doing in Haiti is a collaboration between the National Dental Association, the Harvard School of Dental Medicine, the University of Port-au-Prince School of Dentistry, and the city of Cambridge. We’re all collaborating on a project to do some work in Haiti around oral health and nursing.

I collaborate a lot, and it’s refreshing because within the collaboration, you can get more bang for your buck, but you’re also learning simultaneously from what other people do. What you’re learning is not just knowledge about a particular discipline or situation but also about these people and how to work with them. You’re learning about yourself and how you can or cannot work with certain types of people. With collaborations, there is a lot to be gained.

I think that what I enjoy the most about my work is that it is a constant sharing that takes place. I believe that one of the best things that a human being can do in their lifetime is to share. I used to question why biblically they talked about these three characteristics: hope, faith, and charity. Songs, poems, and all kinds of stuff are being said about that. Then it also goes on to say that the greatest of these is charity. And if you had asked me that, I would say that the greatest of these is faith. I asked somebody that question today, and he said “faith,” and I said “no.” He said “hope,” and I said “no.” Then he said, “Charity is greater than all those things,” and it’s only through living life and experiencing things that you begin to realize what that does for the people or the situation that you are impacting. It also gives you something back, too, and it teaches you something about yourself and about those universal laws—things that have to do with faith.

Growing in faith has been a derivative of sharing, and the sharing part of it is something that is good. I enjoy motivating people and encouraging people. In South Africa, they gave me a Zulu name, and the Zulu name is Siphiwe, which means “the giver” or “someone who gives.” I also find joy in giving. I find joy in watching other people take a seed and run with it. Every once in a while, you get a chance to see some of those products. Our children, family, we see some of those products and sometimes even a colleague or somebody that you may have touched that you didn’t even know. And years later, they come up to you and say, “You spoke at something, and I was inspired by that and did this with that information.” And you say, “That’s remarkable!” I enjoy that part of my work. I enjoy the fact that I get a chance to travel, to learn about other cultures. It is through making comparisons that we appreciate anything. You don’t know what you have until you rub it against something else. It’s just like right and left, and up and down, and high and low, and whatever it is you can theorize about it, but to actually experience it is quite remarkable.

We don’t have time in life to experience everything, but the few things I’ve had a chance to experience have given me a different perspective. It makes me (then) freer; part of the work is being able to interact with different cultures, to travel, and to work—not just to go as a visitor, but to contribute to societies. That is, to me, a blessing. As a result of that, I grow and get more of a perspective. Therefore, now with the years of experience, when I visit people in different parts of the world, I always ask them—because they always ask me, “What did you bring us?”—“What did you bring yourself? What did you bring me?” I say, “Let’s sit at this table together, you asking me what I’m bringing to the table; I’m also going to ask you what you are bringing to the table.” Let’s say that I’m in Kampala, Uganda, and I’m meeting with some dental students. They ask me, “What did you bring?” and I say, “Well, I brought some dental supplies, some surgery instruments?” Then I ask them, “What did you bring?” and they say, “We don’t have anything,” and I say, “That’s wrong; you have a lot.”

The other thing that I bring them is a different perspective. One of the gifts that you offer to people as you gain experience is these perspectives because sometimes, those people would never have the opportunities that you have to physically travel. They may travel virtually, but that’s not the same because it’s often unrealistic. You’re not there to feel it. You can then provide them a perspective that they wouldn’t normally either have or have thought about. When you plant a different perspective in terms of someone’s thought processes, they can’t be the same. They can’t then go back and say, “No, I just thought it was going to be this one way, that I don’t have anything to bring to the table, so I always have to put my hand out and ask you Westerners what you brought to give us.” I say, “Half the time, we bring things to give you that you’re not ready to use. We come back a year later, and it’s sitting over in the grass, all rusty. It could be an idea, or it could be a piece of machinery, but you didn’t know how to use it. So, I bring you a perspective, I bring you some physical tools, but I’m also asking you what you did bring to the table. And don’t sit up here and tell me that you don’t have anything to bring to the table because if you can’t bring something to the table, then perhaps I shouldn’t be here.” And they look perplexed at you because now, you are demanding that they tell you what they’re bringing to the table.

I never forget this one incident, and it was in Kampala, Uganda. These guys said, “We don’t have anything,” and I said, “Think about it. Why do I come here? I come here because you have a different sense of freedom than I have. I need some of that because though you may not have as many material things; where I come from, we’re slave to materialism. We’re slave to consumerism. But you have less of that, so you’re a little freer in some ways than I am. I come here for your vitamin D and your sunshine because it makes me feel happier when I come here. I come here for your naturally grown, fresh food because when I’m here after four days, my body just detoxes. It just goes through a cleansing naturally. And when I replenish it, my whole thought processes, how I feel physically—I feel sexier—everything just changes from being here. In a place that maybe you just can’t see what you have until you go somewhere else and you are able to get that perspective.” That is what I enjoy.

The things that I find less enjoyable sometimes is just that a lot of the things that we want to do take time. Patience and tolerance are not always easy to come by. You have to walk through something before you can get to the other side, and sometimes, the time that I dedicate on one end, I cannot give it back on the other end. We sometimes find ourselves driven, and then that creates an imbalance, and we’re not having that balance and time to give to some of the things that are probably more important. That, I find, is the less enjoyable part. Also, the thing about time is that it’s always moving. We hear that cliche, but what I’m really trying to say is that when you are working really hard and you’ve got all these projects going on—you’re really passionate about them and you’re changing lives—we sometimes don’t realize that the people that are closest to us, the people who just want some quality time from us, we put them off. We put them off, and then they’re 15 years old, or they’re 21 years old. They’re gone, and then just like the song, they don’t have time for you. And you can’t get that back all the time. Sometimes, we really have to look for that balance. So, that’s the less enjoyable part. It’s having more balance when it comes to time, and also not being so habitual about the projects; eventually, I’m going to draw the line, but I don’t necessarily respond to what people tell me to do. I respond to what I feel is the time, so the time is coming close for me to draw the line and reinvent myself again and, in doing so, be more cognizant of how precious the remaining times are.

There have been many obstacles in my career. I think that coming to dental school (I went to UCSF), there was the obstacle of not being wanted in school. I was asked by the assistant dean on my interview if I applied to another dental school. In those days, unlike today, you didn’t apply to ten different schools on one application. You didn’t have the technology to do that. I applied to basically two schools, and then one said my application was late. So, it was just one school. She said, “Did you apply to any other school?” I said, “No, I’ve only really applied to this school.” She said, “Well, I’m sorry to hear that because if I were you, I wouldn’t come here.” I said, “Why would you say that?” She said, “Because this is a very racist institution, and most of your professors don’t want to teach you, and they’re going to give you hell.” And I thought my God, and I said, “Well, I’ve already gone through high school and junior high school and elementary school and dealt with this stuff in undergrad. You mean to tell me I’m going to come to a professional school where I’m going to learn to become a doctor, and there are people who don’t want to teach me and don’t want me to succeed? I would think that anybody who’s made it this far … that the people who are training you would want you to be the best so that you can raise the bar in terms of what comes out of this institution.” She said, “No, they’re going to give you hell.”

Let me tell you: I thought that undergrad was hard because I was the only African American male taking pre-medicine and pre-dentistry in the little old country town up in Oregon. They had never had any black students, and this school is the oldest college west of the Mississippi. Then I come to the University of California in San Francisco, and I’m told by the assistant dean that the instructors don’t want to teach you.

So, we came to class the first week, and we’re all prim and proper, with ties on and white lab coats. And these guys let you know beyond the shadow of a doubt that you’re not welcome. Then, as a friend of mine said, “We zipped up our gorilla suits,” and we just came out swinging. That was four really hard years. It was so hard that it damaged a lot of people. There were people who could not recover. There were people who had to drop out because they felt that they were on the bridge of insanity. There were people who never got a chance to practice dentistry because it seemed to be that they were “blackballed.” They would have never been able to pass the board exams, and things happened to them in between that time. They got injured. They couldn’t work anymore. Things like that happen to people. Divorces were high. Every year, there would be some student, not necessarily in dentistry, who would commit suicide at UCSF.

These stressful things were very difficult. I overcame them by working hard. I overcame them by not quitting. I overcame them by covering my ass as much as possible to make sure that I’ve turned in all my assignments. I completed everything. Even if you told me it wasn’t necessary, I did it anyway because I saw how you really couldn’t trust anyone, and you had to make sure you just covered yourself. I overcame it by studying with groups of students so that we would work hard together. Sometimes, it meant not sleeping and not doing anything but going to the bathroom and brushing your teeth because you’ve been up all night in one of the rooms in the building and then just went downstairs and took your exams.

I got all the way to the California State Board Exam and to have the vice president of the California State Board to say, “You black students might bully your way through dental school, but you will not ever pass the California Boards.” I worked really hard and passed the California Boards on the first try and then became, twenty-something years later, a member of the Board of California Dental Examiners. Some fifteen or twenty years later, I won the Medal of Honor Award, which is the highest award given to an alumnus of UCSF. That’s how I overcame it. I overcame it by beating it. I beat it by not allowing myself to give up and to continue holding my head up and fighting back on a level that people could understand it.

I try to incorporate exercise in my daily routine. My nickname in California that my mother gave me was “Roadrunner.” It meant that I was always on the road. I would wear a car out: tires, engine, everything. My last car was a Land Rover, and it was “put-putting” by the time I got through with it because I put so many miles. I think I had 270-plus thousand miles on that one. I was constantly on the road. California is a huge state, and you have to have a car. I moved to Boston eight and a half years ago, and I haven’t had a car since. I sold the Land Rover and elected not to buy a car here. I came here with sciatica nerve issues on both hips and pinched nerve in the back, and went to a surgeon. He said he couldn’t guarantee anything, and I said, “What do I do?” He said, “Keep exercising,” so I kept walking. One side of the hip got better, and the pain went away, and a couple of years later, the pain on the other side stopped.

I would go back to the towns that I grew up in. All the men my age were either dead, or they were very sick: teeth missing, diabetes, high blood pressure, you name it. Fortunately, I haven’t had any of those things. I don’t take any medications, except vitamins and maybe one aspirin. So, it’s exercise and building it into my lifestyle. I take the subway, and I walk. Occasionally, I take yoga because I feet that if I could stretch the back a little bit, I could take some pressure off the nerve. I like hiking. I like being outdoors a lot. When I travel, I do a lot of walking. I enjoy traveling. I enjoy hiking. I’ll try skiing a little bit, swimming, and things like that, whenever I get an opportunity. But it is the walking that keeps me together.

I love music. I try to play a little percussion every once in a while; it helps to balance out the frustrations. Go beat on something, and what better to beat on than the drum. Boston is a great city for not only health care and education but also for the fine arts. I spend a lot of time in museums here. I spend a lot of money buying tickets to all kinds of events, such as the ballet and the symphony and modern dance. I go to hear a lot of jazz, a lot of world music. I do that a lot. Whenever I travel, I make the best of it. I may go some place on business, but I always carve out a couple of days to jump in the ocean and swim or to participate in some activities.

To continue exploring. Always explore. Always ask questions. Always give things the benefit of the doubt; that’s another thing. Don’t be so quick to become judgmental. Allow things to evolve around you a little bit more. Learn how to become a good listener, an active listener. Hesitate before you open your mouth to make a criticism. Hesitate before you become upset about something. Hesitate before you allow something that has been said or done to disappoint you because in that hesitancy, it allows something miraculous to often happen. Sometimes, it just takes ten or fifteen seconds, but in that sphere of time, in that gap, a lot of things could happen if you just leave it alone. In a conversation with a person, hesitate. Don’t fill up all the conversation with what you have to say. But say something. Make a point, and then stop, and allow that other person to respond or to just become uncomfortable because those become moments of truth. They become moments of something that’s kinds of peer. And it’s quite interesting to be in that. Get your ego out of the way. Eckhart Tolle, speaking of books, writes about the ego and how it really clouds everything that we do. I read that book a little bit while in Rwanda last year, and it really helped me when I started understanding what the ego was, and to practice (in the moment) how to push it aside and allow yourself to be receptive and to be open without being on the defensive and looking for the battle that the ego always wants to have or to compete. That goes back to all that hesitancy stuff: just waiting and giving a chance.

I also say to young people who are exploring that you don’t have to have all the answers. You don’t have to know exactly what you want to do. I believe that you should just choose a direction, and the direction can be quite broad, or it can be narrow. Just give yourself a direction. In doing that, don’t waste a lot of time trying to figure out exactly what you want to do because if you go in a direction, the motion will carry you, and you will pick up the ideas and the tools and what’s needed as you are just going in that direction. There’s too much we don’t know, and there are too many ideas we never heard of, and there are opportunities that are great for combinations of things because you have this passion; you have this desire for that and that, and you can put things together. It’s remarkable that way. You can become successful doing things that you are passionate about. You don’t have to do this one thing that you don’t like just because you believe it’s going to make you money.

I also say that some people love money. That’s their passion, and I am not knocking them. I’m not a lover of money. I’m a lover of other things. That’s my passion. But somehow or another, there is a happy medium where even people like that with those differences can come together. Find a way to make it work in a collaborative way that everyone wins, including the other people or other situations that you may be impacting. Don’t knock and judge a person because their values are not the same as yours.

Create a set of principles for yourself. Learn about ethics a little bit. Learn about economics a little bit, even if that’s not your major. Take an ethics course. Take a physiology course. Take a physics course. Take an economics course. Take those four courses, whether you are going into those fields or not. They will open you up, and they will tell you about how the world could work—does work. It will give you some perspective that will impact any other decisions that you’re going to be making. Those four courses: physics, physiology, ethics, and economics.

The vision is that we will be able to create some tools, both now and in the near future, that we can share with other people who have similar problems that they’re trying to address. Then, we publish papers that people can read about; that we can collect data; that we create methods to train people and expose them about their own health; that we create methods to governments and organizations about how to conduct an intervention and learn from our mistakes as well as our successes, and how you might be able to do something similar. In the process of doing this kind of work, that we be able to demonstrate to people to get out of silos and start collaborating and working together in teams to solve health care issues. We can get there by actually doing the work. We have to demonstrate to ourselves that we can work together. We can’t just talk about it; we have to do it. And when we do it, it becomes more seamless, and we look up all of a sudden one day and see that we are doing it. That’s my vision. Also, I am praying and hoping to find proteges who will bring their perspective in and keep some of these projects moving forward to produce long-lasting or broader sustainability.

One of the principles that has helped me to navigate my life is the principle of praying and to believe and trust that there is a certain level of spirituality that exists in the universe that I can count on. That doesn’t mean that it is always what I want it to be, but that it is constant. Constant, not so much that it does not waiver in terms of it being flexible like the wind, but that it is constant because it’s ever-present, simultaneously. Before I have to do something—climb a mountain, give a presentation, do a project, encounter people at a particular venue, or something I’ve never done before—I lace what I do with prayer. In other words, I try to get in the habit of, every morning, having a special place where I can go and pray and meditate and maybe do a little bit of stretching, yoga or something. It just gets me ready for the day.

The music that I play also participates in that environment that I’ve created. Being able to pray, In other words, trying to keep myself in a reverent, in a humble, and in a meek frame of mind most of the time. It doesn’t mean that I don’t get pissed off. You can set me off, and I can get angry. I can be just like anybody else, but I try to catch myself before I do something totally wrong. I do try to practice being a reverent person and always believing in that reverence, that every situation creates an opportunity to do something better, to do something good. Rather than getting down about what’s happening, I look at those situations as opportunities to improve me because what I’ve learned is that even though I’ve worked most of my days in life toward helping other people, I can’t fix them. I can only create a scenario for them to want to fix themselves; the only person that I can really fix is me. By doing that, it does resonate, and it does help other people when they look at your model that you’ve created for yourself. Part of that is knowing that you are not perfect, that you are imperfect. People look at you and say that you are successful, but you’re also imperfect, and that is true. That means that everybody can do things well and still be imperfect. That’s the principles that I try to navigate through life with.