Podcasts about veterans hospital

Harout Markarian, founder and CEO of MARKBOTIX, shares his journey from Lebanon to the US, transitioning from a professional basketball player to a skilled roboticist. He discusses his educational background in mechanical engineering, robotics, and business, leading to the creation of MARKBOTIX. The company develops GRACE, an assistive robot for the elderly and disabled, aiming to reduce falls and improve quality of life. Harout's passion for engineering and helping people drives his mission to enhance independent living and accessibility. Guest links: https://www.linkedin.com/in/haroutmarkarian/ | https://www.markbotix.com/ Charity supported: Save the Children Interested in being a guest on the show or have feedback to share? Email us at podcast@velentium.com.  PRODUCTION CREDITS Host: Lindsey Dinneen Editing: Marketing Wise Producer: Velentium   EPISODE TRANSCRIPT Episode 039 - Harout Markarian [00:00:00] Lindsey Dinneen: Hi, I'm Lindsey and I'm talking with MedTech industry leaders on how they change lives for a better world. [00:00:09] Diane Bouis: The inventions and technologies are fascinating and so are the people who work with them. [00:00:15] Frank Jaskulke: There was a period of time where I realized, fundamentally, my job was to go hang out with really smart people that are saving lives and then do work that would help them save more lives. [00:00:28] Diane Bouis: I got into the business to save lives and it is incredibly motivating to work with people who are in that same business, saving or improving lives. [00:00:38] Duane Mancini: What better industry than where I get to wake up every day and just save people's lives. [00:00:42] Lindsey Dinneen: These are extraordinary people doing extraordinary work, and this is The Leading Difference. Hello, and welcome back to another episode of The Leading Difference podcast. I'm your host, Lindsey, and I am so excited to introduce to you as my guest today, Harout Markarian. Harout is the founder and CEO of MARKBOTIX, an innovative assistive robotics startup focused on transforming care for the elderly and individuals with disabilities. Harout, a skilled roboticist with multiple patents, holds a bachelor's degree in mechanical engineering, a master's in robotics, and an MBA. His professional path has been marked by significant leadership roles in engineering at top firms, including the Boeing company, where he designed the air refueling flight controls algorithm for the Boeing C 17. At MARKBOTIX, Harout's team is developing GRACE, Ground Robotic Assistant for Care Enablement, robot designed to reduce risks of falls, hospital readmission rates, and caregiver burnout, while providing support for everyday tasks. Under his leadership, MARKBOTIX has garnered significant interest, including over a hundred letters of intent from various facilities and is currently involved in beta testing with organizations like the VA Hospital. Harout is also a published author and speaker, advocating for the right use of robotics to improve independent living and accessibility through his book, "Mobility and Inclusion." His work extends beyond business as he actively contributes to the community, particularly through support for organizations aiding the elderly and individuals with mobility challenges. All right. Well, welcome Harout. Thank you so much for being here today. I'm so excited to talk with you. [00:02:23] Harout Markarian: Likewise. [00:02:24] Lindsey Dinneen: Excellent. Well, I wondered if you wouldn't mind starting off by just telling us a little bit about who you are and a little bit about your background and maybe how you got into medtech. [00:02:36] Harout Markarian: Sure. So I, I am an immigrant from Lebanon, a former professional basketball player, danced ballet for a little bit, and at one point ,my parents decided to immigrate to the United States. Needless to say that my academic career was a tremendously suffering when I was busy with the basketballs and the ballet dances of the world. So, so when they decided to immigrate to the United States. States. I was strongly against it, but deep down I knew that my parents always did things for the benefit of me and my sister. So, unwillingly I followed them. I came to the United States in 2008. I was 23, about to be 24 years old. And at that time, basically everything that I knew disappeared from my life. Everything that was normal to me disappeared. So I had to do something. I had no money. My parents didn't come with money. So I had to support, I had to help, so I worked full time as a waiter and I was also going to school full time to continue my undergrad in mechanical engineering. Mind you that I already completed three years of engineering back in Lebanon. When I got here, they said, "Oh the institution that you attended is not accredited." And my luck, I guess the institution got accredited a year after I left. [00:04:02] Lindsey Dinneen: Oh, no. [00:04:05] Harout Markarian: But it was a blessing in disguise. As I said, I wasn't the best student at the time. So the grades were reflective of that too. So, now that everything is no, no more distractions were in my life, I focused on my studies, finished three years of undergrad in mechanical engineering in a year and a half. My GPA went from 1. 8 to 3. 5 by the time I graduated. And during my final year when I was developing the senior design with my team, I experienced a tremendous shift in my life because I was part of this project where we built a six foot tall, fully autonomous robot. And we won the first place internationally in the autonomous unmanned system vehicle international competition. And that was a really a shift in my career in the way I viewed engineering, I viewed education, because up until that point, it was just to satisfy my parents. I'm like, "Here you go. This is the paper you wanted. Get off my back." But ,but right after that, it was like, okay, I want to know more about this robotics world because I really enjoyed it and I'm very curious individual. So robotics has different disciplines, sub disciplines I should say. So there's a mechanical design team, there's the cognition vision team, there's the electrical team, there's a navigation team. So, and I wanted to learn it all and I got involved with everything. And I really enjoyed it. So I ended up pursuing my master's immediately right after I graduated my bachelor's degree. I pursued my master's in robotics, and I was the only one in my cohort or not just cohort, in that year, that opted out of the, the comprehensive exam and wanted to do a thesis dissertation. Because I really enjoyed it. For me, theory alone doesn't mean anything. I need to see it in application. And that's kind of how I pursued it. I was able to build a stair climbing wheelchair. And that's a scale prototype of a stair climbing wheelchair that I presented it to my thesis committee and I learned a lot. I learned a lot and I graduated, but mind you at this time, I'm already working, I'm five years into my, my career in aerospace and defense. So things are going well. Really nothing medtech or healthcare related in my life yet. Except for that stair climbing wheelchair. And, and the reason for that is because I had the opportunity to work with a severely paralyzed person on brain computer interface technology that allowed him to propel his wheelchair through his thoughts. And when I got signed up to this project, I said, "Oh, moving things with your thoughts. That's cool. Let's do it." So, but I was approaching it like so mindlessly, if you will, because I didn't understand the impact that could have on individuals, especially individuals with disabilities, individual with limited mobility and elderly and everything in between. So while we were testing this technology with this individual, it required some training, basically. It's like an electrode that attaches to your skull. So it's a helmet that you wear. And as you think thoughts, it transfers to electrical signals that moves, that propels the wheelchair, moves the motors, right? A very simplistic way of explanation, of course. And, I was trying to test it by myself. So wearing the helmet, trying to move this wheelchair one way or the other. And it was very difficult because it's not second nature to me. I don't, I'm not a wheelchair user. So I, that's not a thing in my mind, but for this individual who was a paraplegic, it was, that was his legs basically. So for him, it was very second nature, right? So, and he got on there and I put the helmet on, set up everything for him and he was driving his wheelchair like I drive my car. That, that, that's how second nature it was for him. And for a moment there, I felt like I was the one with the disability. I couldn't even move a freaking wheelchair with my, so that was a big lesson for me in terms of understanding how limited we can be in, in different aspects of our lives, right? So, at that point I was, that was the first time I realized when I saw how independence and accessibility, what it meant to that individual. That was the first time in my life I said that I want to start a robotics company to help people become more independent. So, so to, to make their environment more accessible for them and to o for the elderly, to have them age with dignity. And that was the purpose. But nothing happened. I just continued with my life, with my job in the aerospace and defense industry. And then sometime later I decided, okay, I think I have a decent background in the technical side of things. I don't know much about business. Let's go get an MBA. So, so, so I went back to school. I did MBA at Pepperdine University. And I loved it because Pepperdine, at least the cohort that I was in and the teacher that I had, everybody was industry professionals and had their PhDs in their respective fields. So it wasn't, I wasn't just learning theory. I was learning how to apply that theory to real world problems. And that's how I learned that. That's where I thrive, right. And once, once I graduated with my my master's degree from Pepperdine, I, next day I went and incorporated the company. Literally the next day I went there and I was like, "Okay, I'm going to incorporate the company." And that's how MARKBOTIX was born. I'm not a hundred percent medtech. I'm approaching medtech from a different angle, if you will. But part of that, when I incorporated the company, I didn't really know what products or service I was really gonna offer. I knew who I wanted to serve, who were the people with disabilities, elderly, people in home cares, assisted living facilities. But I didn't know how to best serve them and with what. So I took a year and a half of going around and talking to people, basically doing customer discovery. And part of that customer discovery session, I stumbled upon the Ground Robotic Assistant for Care Enablement, which we call GRACE now. And all that robot does it initially, at least all that it did, was to pick items up, retrieve items for individuals so they don't risk a fall and then now they're in back in hospital or they injured something. And we're talking about fragile people, right? So when they injure something, the repercussions from it is really could, it could be hefty basically. And as I kept on talking to people, I built this prototype that retrieves items initially, and I tested it with over 300 people, and the more I tested it, the more apparent the need was. People were actually helping me feature up. So, we started with item retrieval, it went to real time video and audio interaction, remote operability, and other stuff that were included in the robot that right now is in development mode. And that's brings me to today where we're raising our first round of funding to bring this to life. We have a bunch of letters of intents from assisted living facilities and somewhere along the way that the DOD got interested in it. We got in contact with the Veterans Hospital. So everybody seems very interested in working with us. So we're, so today we're raising our first round of funding to bring this to life. [00:11:59] Lindsey Dinneen: Oh my goodness. That's incredible. Well, there's so much to your story. I'm so excited to dive in deeper. But first of all, congratulations on your company and its success and the interest, and I'm so excited because I know you're going to be helping so many people and there's such a need for it. So kudos. [00:12:18] Harout Markarian: That's the goal. Yep. Thank you. [00:12:20] Lindsey Dinneen: Yeah. Yeah, absolutely. So, okay. So your story is so interesting and it has so many different twists and turns. And I'm kind of curious, especially knowing, you started off with basketball and ballet and you did your academics of course, but maybe that wasn't quite the focus, could eight year old you have ever pictured you now doing what you're doing? [00:12:44] Harout Markarian: No. So two things. So I knew I wanted to be an engineer, even though I didn't know what that meant at that time. Ever since I was young, I knew I wanted to be an engineer, but I can confidently tell you that I didn't know what that meant. I just, my dad was a mechanic body shop person. He was an entrepreneur. He has his own place. So I thought that was, that's what I was going to be doing if I studied engineering. So that was stupid I was. The other thing is that, no, I mean, my dad was also a professional basketball player. [00:13:15] Lindsey Dinneen: Okay. [00:13:15] Harout Markarian: So, so having those two in mind, eight year old me would never picture me being here today, let alone leaving the country, right? [00:13:23] Lindsey Dinneen: Yeah. So, do you still do anything with either basketball or ballet or has? [00:13:29] Harout Markarian: No, I don't actually want. So once I left both ballet or dancing in general and basketball, I just completely abandoned it. [00:13:40] Lindsey Dinneen: Ah, okay. Fair enough. Do you miss it? [00:13:43] Harout Markarian: No, I don't, because I mean, it was good while I did it and I did it for a long period, I mean, relatively long period of time. So I did dancing for about 10, 12 years. And basketball, I did it from 16 when I went to professional to 23 years, 23 years old. I mean, relatively short career. But for me, my biggest passion was basketball. Just seeing my dad play, and then me being in that world. It was the biggest passion, and when it was taken away from me, or however you want to look at it, or I gave it up. I didn't give it up. I didn't want to give it up. Even long after it was over, I didn't want to accept that was not part of my life anymore. I was passionless for a while. So, finding that robotics world where I'm interested in something again, was a big shift for me. [00:14:36] Lindsey Dinneen: Yeah. Yeah. That's a really big deal. And that is hard, but I feel like it speaks a lot also to your resilience and your willingness to, to change and to pivot, as much as that word is overused. But you know, the thing is you have such a growth mindset, clearly. I mean, you're such a lifelong learner, you've gone and done the things that you wanted to do, but those aren't easy things that you've decided to do and you've had such a robust career so far. I mean, I love the fact that I think you're such a great testament to the ability to keep learning and keep enhancing your skillsets and keep going even when it is frustrating or you feel like you've lost this crucial part of you, but you still are able to keep going and do something amazing with your life. I think that's... [00:15:24] Harout Markarian: Absolutely. [00:15:25] Lindsey Dinneen: ...courage. [00:15:26] Harout Markarian: I mean, I mean, you have to do that because the only constant in your life is change. So you either adapt or you just fall behind and become miserable. And everything bad that goes, that follows that, right? So, if you don't change, time is moving forward, so you're just falling behind. [00:15:43] Lindsey Dinneen: Yeah. Yeah, absolutely. You started off in your career working for others and you had a amazing experiences, it sounds like, with very well known companies and brands, and then you switched to starting your own business and I know you got your MBA and I'm sure that helps you feel more prepared, but I do feel like there's often this-- once you actually do it, how much you have to learn on the job, so to speak. So I would love if you wouldn't mind speaking about your entrepreneurial journey and how that has changed and grown over time. [00:16:15] Harout Markarian: Yeah, so, so I'll tell you that college education doesn't mean that you're going to be able to thrive in the business world, right? Whether it's a technical side of thing or the business side of things. Unless you dive in there and do it yourself, you're just going to be dumber than a bag of rocks. So, I'm sorry for the expression, but that's that's how it is. Basically what engineering taught me is how to figure things out. They didn't teach me to find a job and hit the road running with that job, right. So everywhere I went, every company I worked for, I had to restart from scratch, go into my baggage of tools that college education gave me and depending on these knowledges, just figure out how to do my current job today and how to learn more. Because what you learn in school is just a baseline thing. It's just nothing really. And nowadays you can learn anything and everything online. I would even argue that nowadays, unless you're a doctor or an engineer a lawyer, maybe you don't really have to go to school. Everything else can be learned online. And there's a lot of resources today that back 10, 15 years ago, we didn't have. So on the job learning is the most real thing anyone can ever think of. Pepperdine came really close because I did my actual business plan to the company that I'm building today, I did it at Pepperdine. So it was a benefit for me because I studied, I got my education at the same time I worked on my business, so that's why I liked it a lot. But don't think that you're going to go to college and you're going to take a job. And all employers know, by the way, all employers know that they're going to teach you a lot when they hire you, they're just hiring you based on, I don't know, your enthusiasm, the willingness to learn, willingness to be adaptable, your demeanor, your behavior. That's what they're hiring. And I'm a Director of Engineering right now at different companies. So I hire people all the time. So that I don't hire them. I don't expect them to know things. I expect them to know basic things, but I don't expect them to hit the ground running regardless of where they are in their career. [00:18:30] Lindsey Dinneen: Sure. Sure. So when you stepped into this, this entrepreneurial journey, and you're the owner of a company, you are the leader of this vision-- did you find that to be a relatively easy transition because of the past experiences that you'd had? Or was that element of stepping into this high leadership role, was that, yeah, difficult in any way? [00:18:56] Harout Markarian: In different things that I tried in my life, I felt like I was always adaptable. I was always willing to learn. And I never quit. I failed a lot, but I never quit. Right? So I feel like that definitely contributed to, to how I'm managing myself in this role. Is it easy? It's not easy at all. It's difficult. Whoever tells you starting a company, building a company is easy, it's out of their mind, especially in the beginning stages. Because having other people get on board and see your vision, it's the toughest challenge a founder can embark on. So if you overcome that, then you definitely have what it takes to lead a company. [00:19:44] Lindsey Dinneen: Agreed. Yeah. Yeah. And so are there any moments that stand out to you as you've started this company or even prior to that, where it just kind of confirmed to you, "Yes, I am in the right industry, at the right time for a purpose." Was there like a moment that you thought, "Wow, this is why I'm here." [00:20:05] Harout Markarian: Well, first and foremost, I pray to God every day. I asked God for his guidance. If it's not part of his plans, please give me a sign. So I just go do something else, right? And till now he didn't give me any sign to abandoning it, but or I'm that, I'm just that's too but that i'm not realizing it but no, that's that's my first go to right? I always embark on my day, on my journey, by asking God to guide me through it. Having said that, the countless numbers of interviews and research that I've done-- and this, mind you, this is not leveraged research-- this is me talking to people one on one. So over 1000 interviews over the past year and a half, or almost two years talking to people, it was reassuring to me that, okay, this is needed and I'm going to be helping a lot of people. And that's really what kept me on this journey. Just now I feel responsible for all the people I talked to. I have a responsibility to see this through. If I focus on the competitors, the market, the investment, the investor, then I would give up long time ago. Then that's not the right way because the market, the investor, the Investment, they didn't do the work I did in terms of talking to the end user and how it's going to benefit them. So they don't really know that, they don't understand that. So it's my job to, we talked about vision, it's my job to clarify the vision to the investor, in this case. So it sees that how many people is going to benefit from this. So that was the reassuring factor. Conducting that customer discovery was so important. Because that sets the expectations for myself and everyone I talk to. [00:21:58] Lindsey Dinneen: Yeah, absolutely. Thank you for sharing that. I think it's helpful, so helpful to have those moments, something to hold on to when it does get hard because it's inevitably going to get hard and frustrating and discouraging at times. So being able to go, "Oh, wow. But I know this is impacting people. And if I don't do it, will anybody else?" That's, but that's powerful to motivate you. [00:22:22] Harout Markarian: Yeah, and I mean, I want more people to do what I'm doing because the market supports it, right? Just, we're talking right now, a little left brain, right? Logic. The market supports it, there's gonna be more people older people. The elderly population is increasing, is going to get bigger. So there should be more companies like mine addressing the same need because one or two or three companies are not going to be able to close the gap. [00:22:50] Lindsey Dinneen: Yeah, absolutely. So what are you most looking forward to both perhaps personally and then professionally with your business? What is on the horizon that you're excited about? [00:23:02] Harout Markarian: Personally, I just want to enjoy my family, enjoy my wife, my kids, my parents before they're gone, because of everyone, everyone's going to leave at one point. So I would love to have some quality time with my parents, with my kids, with my wife. That's on the personal side. That's what's really meaningful to me. On the business side, I just want to add value to people. Hopefully this will be the vehicle, how I'd be able to do that. And as I said, I feel like I have the responsibility right now to see this through just because of all the conversations that I've had with people with different disabilities, with different challenges that this technology could help them overcome that. [00:23:45] Lindsey Dinneen: Yeah. Yeah. And it's exciting. You're in a really exciting growth phase too. So there's a lot to, a lot to be joyful about, I suppose. [00:23:54] Harout Markarian: Yeah. [00:23:55] Lindsey Dinneen: Yeah, that's amazing. Well, pivoting the conversation just for fun, imagine that you were to be offered a million dollars to teach a masterclass on anything you want. It could be in your industry, but it doesn't have to be. What would you choose to teach and why? [00:24:12] Harout Markarian: For them to be connected with God more because I feel like, and I don't know if I'm the right person to teach that, right? But because everything else doesn't matter. Everything else is temporary. I think the divine is, is the only thing that is not temporary. Your spirit, your soul is the only thing that is not temporary. Your challenges, your difficulties, your tough times, your good times, your money, your lack of money, all of that is temporary. What's not temporary is your soul and spirit and what happens to it afterwards. So, a lot of people today are behind social media and the fakeness of the world. And that's what I want to separate myself from, and see if I had the opportunity, I would just teach people to be more authentic and more connected to God. [00:24:59] Lindsey Dinneen: Yeah, absolutely. And then how do you wish to be remembered after you leave this world? [00:25:05] Harout Markarian: I don't know if I want to be remembered, but if I do good to people, if I serve people in this world, in my time here hopefully I'll I please my God. And that's what's important to me, because pleasing God is serving others. So that's what it means to me. If I do that, then hopefully I'm pleasing God and helping people in the way. That's my thing. I don't know what being remembered means really who's remembering me, right? That's the question that I always ask and I wasn't always I didn't always think this way. I didn't always think this way. I always said to myself, okay, I want to be remembered like this great athlete, for example, right, when I played basketball. Or I want to be remembered like the person who founded the biggest assisted robotics company in the world. All that doesn't mean anything, because all that is material stuff, in my humble opinion. And I'm not saying I'm right, right? This is how I think. As, as long as I'm serving others, I'm helping others, hopefully doing it in a gracious way, that's what I'm looking for. [00:26:04] Lindsey Dinneen: Yeah. Yeah. Well, I think that's incredible and that's, I frankly wish that more people felt that way. So I think that's a, I [00:26:15] Harout Markarian: Well, I, it's a hard thing to do and I'm not saying I'm doing it perfectly. Sometimes we have a lot of distractions. That's not the norm So if we follow what's around us, then we're not going to think that way and I struggle with it too. So I constantly strive to keep myself true to what I just said right now. [00:26:32] Lindsey Dinneen: Yeah. Yep. There you go. And then, final question, what is one thing that makes you smile every time you see or think about it? [00:26:42] Harout Markarian: Oh, my kids. My son is five, my daughter is two ,and they're hilarious, even when they're a pain in my ass, so. So, sometimes the things they say is, and then, I like to also I'm a light guy. I like to think that I'm a light guy, so everything is a joke to me. I don't take a lot of things seriously. So I'm always giving people hard time kind of in a humorous way. So I like to pick on my wife, pick on my sisters. So these kinds of things make me smile. Sometimes it's stupid. Sometimes it's makes others smile to you, but it's just light stuff. I just enjoy my life, enjoy the time I have with the people I love the most. [00:27:20] Lindsey Dinneen: I love that. That's fantastic. Yeah, well, first of all, again, thank you so much for sharing your story and your insights. And, it's so interesting to me how you have had such resilience and a growth mindset and now discovered this sense of humor as well. I mean, I'm sure that helped exponentially as you had to go through so many different iterations or stages or seasons, whatever you want to call it of your life. And some of them sounds quite difficult. So I just want to say thank you for sharing that story and thank you for talking about it and giving inspiration and hope to somebody else who might also be in maybe a transition period or something like that, where it might be a little harder. So I, anyway, just... thank you. [00:28:05] Harout Markarian: And I, I don't downplay the challenges, right? Of course I recognize them, but I just choose to take it lightly because as I said, nothing is permanent. Everything is temporary, so don't think too much about it. Just, pray and move along. [00:28:23] Lindsey Dinneen: That should be on a t shirt that you sell or something. [00:28:26] Harout Markarian: Yeah, that's a good idea. I might I'm that might be merchandise. I'll say I sell on MARKBOTIX's website. [00:28:32] Lindsey Dinneen: Please do. That's amazing. I love it. Oh my gosh. That's so fun. Well, this has been such a great conversation. I've enjoyed it so much and I'm very appreciative of you spending some time with me today and talking, and we are so honored to be making a donation on your behalf as a thank you for your time today. And that is to Save the Children, which works to end the cycle of poverty by ensuring communities have the resources to provide children with a healthy, educational, and safe environment. So thank you for choosing that charity to support, and we just wish you continued success as you work to change lives for a better world. [00:29:11] Harout Markarian: Thank you so much. And thank you for your time as well, Lindsey. [00:29:14] Lindsey Dinneen: Of course. And thank you also to our listeners for tuning in. And if you're feeling as inspired as I am right now, I would love if you would share this episode with a colleague or two, and we will catch you next time. [00:29:25] Ben Trombold: The Leading Difference is brought to you by Velentium. Velentium is a full-service CDMO with 100% in-house capability to design, develop, and manufacture medical devices from class two wearables to class three active implantable medical devices. Velentium specializes in active implantables, leads, programmers, and accessories across a wide range of indications, such as neuromodulation, deep brain stimulation, cardiac management, and diabetes management. Velentium's core competencies include electrical, firmware, and mechanical design, mobile apps, embedded cybersecurity, human factors and usability, automated test systems, systems engineering, and contract manufacturing. Velentium works with clients worldwide, from startups seeking funding to established Fortune 100 companies. Visit velentium.com to explore your next step in medical device development.

Of all places you'd expect to proudly fly the American flag, a federally-funded veterans hospital should top the list. So why is the Veterans Hospital in Des Moines actively refusing to raise Old Glory at their main entrance? And taking drastic measures to stop anyone else from doing so? Last June, the same VA hospital decided to replace the U.S. flag with...another flag. Guess which one. State Senator Adrian Dickey describes this incredible controversy as he fights to keep the flag at the VA Hospital's main entrance--again. And the hospital administration is going to outlandish lengths to keep removing the American flag that honors the very veterans they exist to serve. Become a supporter of this podcast: https://www.spreaker.com/podcast/faith-works-live-with-rebekah-haynie--5411714/support.

[00:00:00] John Ashmen: I think that's always important, that you have people that tell you the truth. And, we have different places where that happens. It's not just in the work environment, but also in small groups and fellowship groups and things like that. We have the opportunity to either take their advice or not take their advice. You can surround yourself with great people and they can tell you the truth. If you don't listen to it and take their advice, then you don't emerge any better than you were when you went in. +++++++++++++++++++++ [00:00:30] Tommy Thomas: Our guest today is John Ashman, the CEO at Citygate Network. Prior to Citygate, John was the Chief Operating Officer at the Christian Camp and Conference Association, giving him a total of almost 30 years in association leadership. John has led Citygate through a reassessment, a relocation, a restaffing, a refocusing, a rebranding, and then ultimately through the pandemic. John has led Citygate through a reassessment, a relocation, a restaffing, a refocusing, a rebranding, and then ultimately through the pandemic. Through all of this, the Citygate Network membership has grown by almost a third. In addition to his day job, John is a prolific writer, speaker, and board member of several nonprofit organizations. John, welcome to NextGen Nonprofit Leadership. [00:01:12] John Ashmen: Thank you, Tommy.  Good to be with you. [00:01:15] Tommy Thomas: Before I jump too deep in, is there a short story about how you got into association leadership? [00:01:23] John Ashmen: I was a camp director in New Jersey, a youth camp that was located halfway between Philadelphia and Atlantic City, had about 15,000 people a year come through on all of our programs. It's New Jersey, a very populated state, and the whole Delaware Valley is quite crowded. And we did camping programs up in Maine and over in Europe as well. And being in that camping world gave me visibility. And I went on the board of Christian Camp and Conference Association. At some point, one of the people who was also on the board at that time ended up taking the position of president of that association and gave me an invitation to come and also be on that team. So that's where I served those years as Vice President and Director of Member Services, which is essentially the COO position at Christian Conference Association. That was the launch. [00:02:20] Tommy Thomas:  What do you remember about your childhood that was formative? Were y'all big campers as kids? What stands out there? My father had a mantra that was pretty much built into his life philosophy and that was never let school stand in the way of your kid's education. [00:02:31] John Ashmen: My father had a mantra that was pretty much built into his life philosophy and that was never let school stand in the way of your kid's education. And so, we would take train trips across the U S and in the middle of September and October when some of my friends were in school and somehow, I always was able to do it and I never got in trouble and I guess he didn't, maybe he never told me, but I was always involved with something in adventure and activity with my family. Myy dad and mom for their honeymoon, for example, were married in Ohio and decided they would go out to Illinois and see his brother. They got to Northwestern where he was teaching and he convinced them that Yellowstone National Park was not that far down the road, so they put a case of Campbell's soup in their trunk and took off and found out it was a little bit further than they thought and so they got to Yellowstone and they said we'll never be this close to California, let's try that. That was the parents that I had and the upbringing that I had, so adventure was always on the horizon. [00:03:40] Tommy Thomas: What was high school like for you? [00:03:42] John Ashmen:  What was high school like? Boy, that's a question I don't get in many of the interviews that I do on a regular basis. High school was a great experience. I didn't have problems. I came from a rural part of New Jersey. They're hard to find them anymore. In fact, in my grammar school days, we had outhouses for the first two years.  I'm not all that old, but that's the status of the area where I grew up. But I went to a regional high school and probably was involved in the usual stuff.  A few sports teams, and in the band. I look back on high school with fond memories. [00:04:25] Tommy Thomas: When you went to college, how did you declare a major? What was involved in your decision? [00:04:28] John Ashmen: I was in a music group at the time. This was in southern New Jersey, South Jersey for the locals, that's how it's known. And I didn't want to go too far away to college because I didn't want to drop out of that group. And so, I went to the college where my parents had gone, where they met, which eventually became Cairn University. At the time, the school was called Philadelphia College of Bible, and it generally prepared people to go into a career in church music or go on to seminary, so I looked around at all those things that were preferred. I wasn't interested in going on to seminary, and even though I was musical, it wasn't going to be a career. I looked at education, that's where most of the people were, and the one that interested me the most was social work. And I declared social work as the major, actually, everybody majored in Bible and you had a minor, and so it was social work, and so I left college with a Bachelor of Science in Bible with an emphasis on social work and didn't use it right away. I did work part-time. Some of my fieldwork assignments were to be a chaplain at the Veterans Hospital and to be a parole officer, probation officer, in Philadelphia, but went into camp work, and that Christian camp that we mentioned was the one that when I spent the first 15 years, took over from my father and he was the person who started that camp, determined it was time to do something different. [00:06:14] Tommy Thomas:  What do you remember about the first time you had people reporting to you? [00:06:17] John Ashmen: It was at the camp. And I just remembered that the folks that were there were just fun to be with. And we made it as creative and unique as possible. We just had a lot of opportunities to really join together in a unique way in a camp setting. We did not run a traditional office setting or environment. Everybody was out and about, and we would meet in some of the most unusual places, out in the Pine Barrens. And we just made it like an adventure every day that we would get together. [00:07:01] Tommy Thomas: I think successful people are asked all the time, what makes you successful?  I'd like to frame the question this way, and that would be, what is a factor that's helped you succeed that most people on the outside probably wouldn't recognize? [00:07:17] John Ashmen: I'm told I'm creative and flexible. And so that is probably something that is a standout characteristic. In the strengths finder ideation is one of my strengths. But strategic is also a strength. As we are going through a leadership transition here, my leadership style has been talked about particularly by the board as they were looking to find my replacement. I am an expressive driver, which means I come into a situation, assess it pretty quickly, and then pick a direction and get people to follow me.  And that's worked for 30 years and 15 before that at the camp. That would be who I am. ++++++++++++++++++++ [00:08:00] Tommy Thomas: What's the most creative thing you think you and your team have ever done? [00:08:08] John Ashmen: 15 years in camping, 15 years with the Camping Association, and then 16 years with the Mission Association, and having had music in my background. 3 years ago now, 4 years, I guess, I talked to our friend, Amy Grant, from Nashville.  Most people know who Amy Grant is and we said, what if we bring together the rescue mission dynamics, the life transformation attributes that are kind of part of helping people change their life? And then also blend in the unique outdoor setting and the dynamics of creative outdoor initiatives. And then also music. And so, we started something called Hidden Trace Retreat. And we've got a couple more scheduled here in another month. Amy Grant worked with Citygate to establish Hidden Trace Retreat And they've just been wildly successful where we bring people from a rescue mission going through a life transformation program, people who have previously been on the streets to continue with some of that teaching, but also use the outdoor setting and group initiatives and farm chores and those kinds of things to change their environment and give them total new experiences and see themselves in a different way. We do What's My Name? We talk about what your name means and whether you're living up to those attributes. What's my story? Where did you come from? What's my style? We go over social styles. What's my plan?  What's my future? And when we get to that, what's my story, we bring in singers, songwriters, people like Amy Grant or others in Nashville. Cindy Morgan's been very involved with this, Mark Elliott and they listen to the stories of people who have been on the streets, go home, and craft these amazing songs so that when we all get together in the barn on the climax of the program, they hear songs about their life story sung by Nashville musicians. And that has been something that's gotten all kinds of accolades and awards for being a creative, unique program. That ranks up there. It's relatively current. [00:10:39] Tommy Thomas: What times in your life have really tested your mettle and how did you come out of those? [00:10:51] John Ashmen: Anytime there is a unique change in people's environment brings a lot of responses that you can expect more specific. When I came to Citygate Network, I was the first person in a hundred years, literally, to run this association of at the time, a couple of hundred rescue missions who never actually ran one. And I was never a mission superintendent as they called it. And so that put a pretty good target on my back. And when I came up with things that are presented to the board that were needed to be done to basically, save the association, that wasn't met with a lot of applause because they saw this as critical change.  And so that was probably one of the trying times. And I persevered and I told my board chair that you have to be my armor bearer. And I told my executive assistant, I don't want to read any of the comments that are coming in on email or social media about what people think of my decisions.   I'll just measure it by what we accomplish. [00:12:15] Tommy Thomas: Is there a point during that transition when you saw that y'all had turned the corner? [00:12:22] John Ashmen: Yeah, there was. One of the things that really helped, Tommy, was that I wrote a book on the whole idea of hunger, homelessness, abuse, and addiction called Invisible Neighbors. And that book actually went through three printings and sold very well. And when all of those members, now organizations, number over 300. When those people saw that I understood what they were about and could voice it even the way that they couldn't, there was much broader acceptance, and then when they saw the positive changes and the connections to federal governments and the links we were making there and the unique public relations initiatives and involved with movies like Odd Life of Timothy Green, Same, Different as Me, I think they also, they said, hey, this is going the right direction. And we want to be part of it. And so that's why our membership has grown 50% since I've come. [00:13:28] Tommy Thomas: What lesson do you think y'all brought out of the pandemic that you'll take forward? Collaboration is paramount.  I pushed collaboration from the very beginning of the pandemic.  Faith-based organizations, particularly in the nonprofit world, had become very siloed.  That was hurting us. [00:13:34] John Ashmen: Collaboration is paramount. That's an easy one for me. I pushed collaboration from the very beginning. Faith-based organizations, particularly in the nonprofit world, had become very siloed. This is our group. This is what we do. And even when I came to try to get people involved in government relations was, oh, we don't want to get involved with government. The camel gets its head under the tent and pretty soon the whole camel disappears and we'll get eaten up. My statement was, hey folks, if you're not at the table, you're on the menu. If you're not at the table, you're on the menu. And so let's see what we can do to build bridges. We have different philosophies about what's going on and we have different ideas of what the solution is, but let's at least talk to one another and see where we can work together. So we started not only building connections to the government but also we're encouraging members to reach out and see who around you is a partner in what they're doing.  And so a lot of our members became friends with those people running Dream Centers or Adult and Teen Challenge or Salvation Army, or whatever it happened to be in their city and started to have good relationships. Things like, hey, here's another mission nearby and they have a great women's program and we have a great men's program but their men's program isn't that good. And maybe we can be the men's program. Let them have the women's program. We'll send our women over there. And so the collaboration that started at that point was something that was already in place when COVID came. And when we determined that we needed to have a bubble, the safe place. And then we needed to have a place for rule-outs. And then we needed to have a place for quarantine. We had to have a place for isolation. We had different missions or ministry organizations sharing those responsibilities. Likewise, I was asked to be on the U.S. Interagency Council COVID 19 Task Force, U.S. Interagency Council on Homelessness, USICH. And I was on there with the U.S. Department of Housing and Urban Development. People from Health and Human Services. The White House had a representative on the call. Department of Education, Department of Labor. A couple of other groups were on there. Of course, FEMA was on and the Center for Disease Control prevention was on and the only three non-government agencies on that call were the Red Cross, us, and the Salvation Army. And we were collaborating at the highest level through the entire COVID pandemic. [00:16:26] Tommy Thomas: Richard Paul Evans, the best-selling novelist, said that sometimes the greatest hope in our lives is just a second chance to do what we should have done right in the first place. When you think of a staff team and somebody that needs a second chance what's going through your heart and mind there? [00:16:47] John Ashmen: If we're talking about what I'm seeing at missions they are there. They're paramount in this area. Many of the people who staff missions were former clients. In fact, many of the CEOs are products of their own program. I've taken so many trips to rescue missions and touring with the CEO and, here's our kitchen and here's our men's long term recovery dorm. That was my bunk up there in the corner when I went through the program. And I just see that happening all over the place. I was within six different missions. Last week one of them called, Hope the Mission, used to be called Hope in the Valley in the Burbank area. They had something on their wall that said you can't go back and change the beginning, but you can start where you are and change the ending. I tell people on both Christian networks and secular networks that the Bible says life comes with a reset button, a second chance button.  Any person being in Christ, they can be a new creation. And that's what so many of our members are doing, seeing these people who are having second chances, as you put it, Tommy, go and finish well.  I tell people on both Christian networks and secular networks that the Bible says life comes with a reset button, a second chance button. Any person being in Christ, they can be a new creation. Old things pass away, and everything can become new. 2 Corinthians 5:17. So that is part of what we're about and why Citygate Network has done the work it's done so well. ++++++++++++++++++++++ [00:18:17] Tommy Thomas: Maybe aside from your dad, have you had mentors in your life who made a significant contribution? [00:18:24] John Ashmen: One that I would immediately go to is someone who's passed away now. His name was Lloyd Mattson. And he was a mentor from afar. For most of my life he'd write books, and the books that he wrote, I would follow and just emulate the things that he was doing. The creative side came out. I started quite a few camping programs because of the work that he had done and the positions that he had taken on things. Lloyd Mattson certainly was one of them. I would say that the person I worked with at Christian Camp and Conference Association after I left directing the camp, his name was Bob Koblish.  He was a mentor as well. I learned a lot about association work from him and, interestingly, he says he learned a lot from me, but I think we learned from each other and that's noteworthy as well. [00:19:19] Tommy Thomas: Certainly, the Koblish family is good stock.  I mean you got a good family there that have made a great contribution to both the Christian world and society in general. [00:19:33] Tommy Thomas: I don't know of Rob Hoskins down at One Hope, but I saw a posting he said the other day, surround yourself with people who know you better than you know yourself and will tell you the truth out of love.  That's how we grow.  How do you resonate with that? [00:19:48] John Ashmen: Yeah, it's like the tombstone sometimes, credited to Andrew Carnegie, but I don't think it really is his. It says, here lies the body of the man who surrounded himself with better people than he was. I think that's always important that you have people that tell you the truth. And, we have different places where that happens. It's not just in the work environment, but also in small groups and fellowship groups and things like that. We have the opportunity to either take their advice or not take their advice. You can surround yourself with great people and they can tell you the truth. If you don't listen to it and take their advice, then you don't emerge any better than you were when you went in. You can surround yourself with great people and they can tell you the truth. If you don't listen to it and take their advice, then you don't emerge any better than you were when you went in. [00:20:28] Tommy Thomas: What's the most dangerous behavior that you've seen that derail leaders' careers? [00:20:34] John Ashmen: Some people don't like to be seen as making a mistake and if they do, they hide it. I think pride is there as well. I think the other thing is that for so many leaders, their self-worth is tied up in what they are doing and not who they are, particularly who they are in Christ as Christian leaders. And so, when it comes time to let go of an organization and hand it over to somebody else that those tentacles wrap around and you find that they're not really willing to let go and it starts destroying the organization unless there can be some quick chopping of those tentacles to move. This whole thing of succession is really critical. We did a survey of our 320-plus organizations back in the year 2020. And we asked hundreds of questions and we've got a lot of valuable information, but one of those was. I didn't know how long they expected to work and 39% of our CEOs said they would be leaving in the next four years. So that was COVID right at it's prime point. I think a lot of people were tired and we thought maybe that wouldn't be the case, but it doesn't seem to be inaccurate. We're seeing people come and go, quite a bit.  We probably have about 30 of our member organizations that are in transition right now. And that just comes back to this idea, we're seeing who's able to let go and who isn't. The future of those organizations depends on how well succession is handled. [00:22:22] Tommy Thomas: Stan, with succession, you've obviously seen a lot of it in both of your career tracks. How soon should a board and a CEO begin to think about that? [00:22:36] John Ashmen: I believe a succession plan should exist as soon as you hire someone. You don't decide, here's what we need to do because the CEO needs to leave right away. We have documents that we tell our members to put a succession plan together. Here's sample documents, what it looks like. You have a succession plan that is timed. Planned succession. You have one that's an unexpected succession. We even have documents that go to boards that say here's what not to do when you find yourself in the midst of an unexpected transition. And then once you have that plan, put it in a policy manual and put it on the shelf. I tell CEOs when they ask me that question, I get a lot of them asking me when should I mention it to the board? I said, when you are sure you are ready to leave and it's going to be within two years. Because if you start talking about that, even hinting at it to your board, their whole mindset changes and they look at you as somebody who's in the process of going. They aren't willing to take risks and you may be wanting to finish a project and they're not willing to put the extra effort or time or money into it because they sense that a change is coming. There are right ways to do succession and there are certainly wrong ways to do it. I like to think that I've rescued quite a few people from announcing things prematurely and helping them figure out how to end well. +++++++++++++++++++++++++++++= [00:24:18] Tommy Thomas: Next week, we will continue this conversation with John Ashmen. During that time, we'll discuss succession planning, John's recent transition from leadership at Citygate, and how he and the board handled that transition. We'll talk at length about board governance. Then I asked John the question that seems to be getting a lot of traction lately. My shark tank question. If he were a panel member of a nonprofit version of Shark Tank, what would he have to be convinced of before providing startup capital to the nonprofit organization?   Links & Resources JobfitMatters Website Next Gen Nonprofit Leadership with Tommy Thomas Citygate Network Website Invisible Neighbors – John Ashmen   Connect tthomas@jobfitmatters.com Follow Tommy on LinkedIn

In this episode of “Solving for X,” Nina Bianchi and Ben Park sit down with Dr. Kavitha Reddy, an Emergency Medicine Physician and the Associate Director of the Employee Whole Health Initiative at the VHA's Office of Patient-Centered Care and Cultural Transformation. Dr. Reddy's journey began with a personal experience of burnout and a critical realization about the connection between health care workers, patient experience, and outcomes. Dr. Reddy shares insights into her team's dynamic transformation work dedicated to bridging the gap between veteran care and employee well-being, explaining how you can address both system change and employee whole health. She also discusses the efforts to grow a Chief Wellness Officer network, the REBOOT Task Force, a dedicated initiative by the VHA to (R)educe (E)mployee (B)urnout and (O)ptimize (O)rganizational (T)hriving, led by determined individuals committed to health workforce well-being. Tune in as we explore the critical role of leadership and the journey toward reshaping the healthcare system to ensure the well-being of employees and, in turn, the quality of care for patients. Don't miss this insightful conversation with a passionate advocate for positive systemic change in healthcare.

In the last episode (019),  I briefly stated my first encounter with Alzheimer's Dementia through my grandfather. Despite the popular belief that this disease was a right of passage for every old person, I have come to learn that this myth is still very prevalent in our African communities. Some people even attribute Alzheimer's to witchcraft or a curse. I suppose it is still difficult to understand and, most importantly, accept that it is nothing other than a disease. Therefore, I have invited a familiar face to this platform in the person of Dr. Leonard Ngarka (neurologist), and Vivian Ngang (aka Aunty Vivian) to have an in-depth discussion on Alzheimer's Dementia and give us more insight from a healthcare provider and caretaker perspective.  Dr. Leonard Ngarka will focus more on educating our community about Alzheimer's Dementia while Vivian Ngang will share her first-hand experience on how she applied the knowledge shared with respect to caring for her mother (listen to her story in episode 019). I hope you learn and pick some key points from this episode, and as always, I hope the conversation continues within your circles. Thanks for listening.    Meet Our Guests: Vivian Ngang is a Registered Nurse with a doctorate degree in Nursing and a Master's degree in Nursing Science. She is a Clinical Nurse Manager in one of the hospitals or one of the units at the Veterans Hospital in Detroit, Michigan. She has been married for 25 years – blessed with four beautiful children and one grandchild. Dr. Leonard Ngarka is a Neurologist who works at Yaounde Central Hospital, Cameroon. He is also a Lecturer at the Faculty of Medicine and Biomedical Sciences, The University of Yaoundé, Cameroon.  Contact Our Guests:   E-mail (Dr. Leonard Ngarka): lngarka@yahoo.com   E-mail (Vivian Ngang): drmangye2020@gmail.com  Facebook: Vivian Ngang   Things You Will Learn in This Episode:  [00:01 – 03:00] Introduction Getting to know our guests [03:00 – 30:00] Remembering Maa Lucy & Learning About Alzheimer's Dementia Remembering Mama Lucy  Mama Lucy's battle with Alzheimer's Dementia What is Alzheimer's Dementia? Signs & Symptoms of Alzheimer's Dementia The different types of Alzheimer's Dementia The risk factors that cause Alzheimer's Dementia [30:00 – 40:00] Prevention & Treatment Changing diets & eating habits Importance of exercising and reading Indulge patients in activities they loved to do before their diagnosis Patients must follow their drug prescription Make patients feel seen, loved, and appreciated [40:00 – 1:00:00] Elaborating On Some Important Key Points Being respectful and patient with people battling Alzheimer's Dementia Ms. Vivian shared some important tips to help caretakers How Vivian improved her mental health being a primary caregiver Advice to our community and caretakers of dementia patients [1:00:00 – 1:13:00] Final Words Dr. Leonard's Final Words Vivian's Final Words Anyoh's Final Words   Quotes “Remember that these elders going through Alzheimer's Dementia are used to giving instructions, giving orders, and doing what they want so we must learn to speak with them calmly, be patient, and be respectful with them in order for them to allow us to offer them the care they need.” – Dr. Leonard Ngarka “When people start having these memory problems – sometimes, we caretakers are so impatient with them that we end up frustrating them. Frustration and becoming depressed even makes their symptoms worse. So we need to be tactful and make them see the need for medical advice rather than making them feel they're close to madness or making them feel they're so bad.” – Dr. Leonard Ngarka  “What are the things we should do to prevent Alzheimer's Dementia? We should eat healthily, engage in sporting activities often, and if we are sick of any chronic condition then we should take our drugs well, and make sure we are well controlled.” – Dr. Leonard Ngarka   LEAVE A REVIEW and tell us what you think about the episode so we can continue putting out the best content just for you! Connect with Living African Podcast: You can connect with us on Facebook, Instagram, YouTube, or Twitter, or send us an email at hello@livingafricanpodcast.com. Check out our website www.livingafricanpodcast.com for more resources and to learn more. Connect with host, Anyoh: You can connect with Anyoh on Facebook (@anyohf), Instagram (@anyohfombad), and Twitter (@anyohfombad). Thank you.

Over 2  million people lived with dementia in sub-Saharan Africa in 2015 and numbers are projected to nearly double every 20 years, increasing to almost 3.5 million by 2030 and 7.6 million by 2050.*  My late grandfather died of a broken heart, but he also had mild symptoms of Alzheimer's dementia. That was my first encounter with this disease and I remember as a kid, struggling to understand why a grown man will forget things so easily or walk out of the house without knowing where he was headed, and getting lost. I remember most people calling it “Old age” and we were made to understand that it was a right of passage for every old person, and that made me even more scared to get old.  Our community has normalized the ideology of defining people's lives by the disease they are battling - in this case, Alzheimer's Dementia. We tend to easily forget that these were humans - family, friends, etc - behind the disease. So this week, we discuss Alzheimer's Dementia from a caretaker's perspective. We will be having Vivian Ngang (aka Aunty Vivian) discuss her experience while taking care of her lovely mother (Mama Lucy) who battled this disease until her demise. This episode is heavy, emotional, and educational, and sheds more light on how we can help our senior relatives encountering this disease. Hope you learn and pick some key points from this episode – remember to share within your circle. * Data From Alzheimer's Disease International (ADI)   Meet Our Guest : Vivian Ngang is a Registered Nurse with a Doctorate degree in Nursing and a Master's degree in Nursing Science. She is a Clinical Nurse Manager in one of the hospitals or one of the units at the Veterans Hospital in Detroit, Michigan. She has been married for 25 years – blessed with four beautiful children and one grandchild.   Contact Our Guest: E-mail: drmangye2020@gmail.com  Facebook: Vivian Ngang   Things You Will Learn in This Episode:  [00:01 – 03:00] Introduction Getting to know our guest [03:00 – 30:00] Remembering Mama Lucy & The Beginning Of Alzheimer's Dementia Who is Mama Lucy? Mama Lucy getting diagnosed with dementia The timeline of the disease and how it progressed Sending her to a nursing home and bringing her home Some of the challenges faced taking care of Mama Lucy [30:00 – 55:00] Events That Happened Before Mama Lucy's Passing Sending Mama Lucy's back home to Cameroon The few weeks before her passing How taking care of Mama Lucy impacted Aunty Vivian The impact Mama Lucy's death had on the family [55:00 – 1:15:00] Elaborating On Some Important Key Points Celebrating Mrs. Vivian Ngang Researching the disease, changing diets, and other important things you can do for dementia patients How Aunty Vivian improved her mental health being a primary caregiver Advice to our community and people taking care of dementia patients [1:15:00 – 1:25:00] Final Words Aunty Vivian's Final Words Anyoh's Final Words Quotes “There's this stigma that someone having Alzheimer's means they're crazy which makes most Africans not want to talk about it so when I started sharing how my mum was dealing with hers, it inspired others to share how their parents were dealing with the same disease. So we must talk and share with others in order to raise awareness and educate our community.” – Vivian Ngang “I want all your listeners to know that God won't give them challenges they don't the strength to handle so they must keep on and not give up.” – Vivian Ngang   LEAVE A REVIEW and tell us what you think about the episode so we can continue putting out the best content just for you! Connect with Living African Podcast: You can connect with us on Facebook, Instagram, YouTube, or Twitter, or send us an email at hello@livingafricanpodcast.com. Check out our website www.livingafricanpodcast.com for more resources and to learn more. Connect with host, Anyoh: You can connect with Anyoh on Facebook (@anyohf), Instagram (@anyohfombad), and Twitter (@anyohfombad). Thank you.

Amazon Books In addition to being a writer of short stories and other professional materials, Dr. Doris N. Starks has had a career in Nursing Education Administration. Her last appointment was that of Dean and Professor of Nursing, as well as Founder and Director of the Community Health Center at Coppin State University in Baltimore. Dr. Starks has been on the faculties and leadership teams at Tuskegee University, Baltimore City Community College, and Coppin State University. She has also served in the U. S. Army Nurse Corps and at the U.S. Veterans Hospital in Tuskegee. Clinical practice for her Master of Science in Nursing was completed at Walter Reed Hospital in Washington, DC, while enrolled at The Catholic University of America.

Although we are late dropping this episode of Folk(e)s Unfettered's nugget of Wisdom this Wednesday, we have a very good reason for doing so, we have been doing acts of service and we have been taking care of our physical health as I prepare for an upcoming surgery. This means I have been dealing with the Veterans Hospital and Veterans Affairs and there will be a series on Veterans' healthcare and the bureaucratic obstructions designed to increase the difficulty of veterans who were injured in service to their country to be acknowledged as having a service-connected disability, even if the servicemember's records show treatment for an injury. But, First, let's tackle the subject of what I call Soft skill thieves, these are individuals who come to you under the guise of wanting to collaborate on a project or enlist your services, when in fact, they are seeking to gather the information they can acquire without compensating you for picking your brain. In this episode, I share my experiences and my solutions to avoiding these time-wasters in order to discern individuals who value my time, experience, and expertise and are willing to pay for it, from those who are simply seeking to hack my brain for free. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app --- Send in a voice message: https://anchor.fm/folkesunfettered/message

Ashley received her Bachelor's degree from Florida State University with a degree in International Affairs with a minor in Religion. She began working in the insurance industry and obtained a Masters in Healthcare Administration to make herself more marketable for the company. Even with multiple degrees something deep inside her heart was yearning for something far greater than what her employer could offer her. She wanted to care for people. She obtained her a Associates' degree in nursing in 2012 and started her nursing career in the NICU taking care of tiny babies! Still feeling like she was missing something in her nursing career the thought of being a psych nurse seemed thrilling. She was offered the job and from day one, she was finally "home" because that "feeling" was GONE! She was and is currently working at an acute psychiatric unit at the Veterans Hospital, As she cared for the veterans and listened to their stories, she walked away wondering - What contributions can I make to the world to prevent people from feeling this way?" She returned to school in 2019 in pursuit of becoming a Psychiatric-Mental Health Nurse Practitioner (PMHNP) and graduated in August 2021 from the University of Alabama at Birmingham. She then released her apparel company PsychLife Tee Co. from her desire to create a positive experience for those who felt "different" by normalizing the conversation around mental health. Her challenge to all mental health professionals is to keep going and to start a movement UNTIL THE STIGMA IS NO MORE! Doctor Nurse Links: https://linktr.ee/DoctorNursePodcast Wanna start a side hustle? Subscribe to the Doctor Nurse Podcast and I will show you how to start: https://view.flodesk.com/pages/6253188857d9b15fd00f8329 Ashley Links: https://psychlifeteeco.com/pages/about-us

In this episode, AiArthritis CEO and person living with Axial Spondyloarthritis - Tiffany Westrich-Robertson - and Dr. Lisa Zickuhr - rheumatologist from Washington University - continue the conversation around shared-decision making and its importance around patient-rheumatologist communication. They focus on a research project both are involved in, and that YOU can join! The project aims to explore patient-reported and rheumatologist-reported barriers to virtual care and, in turn, work towards developing shared-decision making guidance for rheumatologist to adopt in e-health situations.  They also took the opportunity to break out into a segment on COVID-19 and shared-decision making, This segment will be separated from the main show soon, available as it's own minisode, as a "360" spin off from our RheumyRounds and COVID-19 & AiArthritis episodes.    SHOW NOTES 00:54 - Tiffany welcomes listeners. 01:04 - Tiffany is the CEO of AiArthritis, one of the many patient co-hosts from around the world, and a patient living with non-radiographic axial spondyloarthritis. 1:30 - Tiffany is joined today by Dr. Lisa Zickhur, rheumatologist from Washington University Rheumatology and the school of medicine. Lisa also has an interest in education and helps train fellows, or “doctors in progress.” 2:41 - Currently Lisa is working with Tiffany and AiArthritis on a shared decision making project - especially in the virtual environment, which is the topic revisited today. 4:50 - Tiffany revisits the methodology of the show, explaining there are 6 steps to all the work done at AiArthritis and the talk show episodes fall into Step 2 or Step 5. Community input happens in Step 3, which we also circle back to after Step 5. Step 6 is when we create resources based on all the input. 5:31 - This is a Step 5 episode 5:50 - Lisa explains her experience in shared decision making and teaching rheumatology fellows. 6:46 - Tiffany revisits the first episode where we “put the topic of e-health on the table” after she and fellow patient Co-Host, Deb, attended EULAR 2018.  7:45 - Shout out to Dr. Auralie Najm, who was speaking at EULAR 2018 about e-health, where there was a debate that e-health was still at least a decade away from implementation. 9:01 - E-health is thrust upon us in 2020,  around the time shared-decision making builds in popularity. 9:44 - Shout out to Dr. Al Kim, or Dr. Al, or “just Al”, also from Washington University, who also discussed patient-doctor communication in the original RheumyRounds series, which included addressing “Dr. Google”.  But with COVID onset, patients stopped coming to office visits with knowledge and instead turned to their doctors for complete guidance. 10;31 - Lisa speaks from the doctor's perspective regarding early COVID challenges. 11:07 - Tiffany and Lisa talk continue discussing how shared decision making has evolved and now “it's everywhere.” And it's why it's so important right now. 12:25 - Doctors aren't all still great at shared decision making and it's good practice for patients to learn how it works and how to engage in it. 13:02 - AiArthritis already has several projects, including this new one with Lisa and Washington University, underway. Learn more at www.aiarthritis.org/initiatives or sign up (FREE) for AiArthritis Voices to stay informed of all opportunities we have: www.aiarthritis.org/aiarthritisvoices.  13:46 - They are also creating tools to help teach patients, fa 14:09 - Lisa talks about another project just completed around e-health, which was to take general telehealth competency guidance and revise it to be more meaningful in rheumatology virtual visits (and for use by rheumatology fellows in training). Some were specific to shared decision making. Tiffany was the one patient representative on the panel of twelve. 17:30 - Lisa tells the audience about the new project Washington University is working on with Tiffany from AiArthritis, along with Catherine McCarthy from the Veterans Hospital and Emma Nolan-Thomas who is a medical anthropology student (and person living with Sjogren's Syndrome), which aims to identify the best shared decision making practices in virtual rheumatology encounters.You can get involved by signing up at www.aiarthritis.org/initiatives.  19:29 - Tiffany further explains a methodology originally developed by AiArthritis, where patients - trained as professional focus group moderators help facilitate the research. This is incorporated into the Washington University project, with Tiffany as one of the moderators.   21:39 - Special shout out to Washington University for their work including patients as partners in their work. 24:39 - How to get involved in the Washington University project. These focus groups are underway. If spots fill up, you can still be part of the conversation with AiArthritis on this topic. Just sign up to learn more about this and our other research projects at  www.aiarthritis.org/research.   26:32 - TIffany and Lisa break out to discuss the importance of continued shared-decision making as COVID-19 vaccination recommendations continue to evolve. They specifically cover the topic of the 4th vaccine for persons immunocompromised.  This is going to become its own “360” spin off segment under our RheumyRounds series.  38:44 - AiArthritis has created a letter for patients having issues gaining the 4th dose to share with pharmacies. You can find this and other guidance at www.aiarthritis.org/covid19  41:00 - Tiffany and Lisa close out the episode. Tiffany mentions to visit us on social media at @IFAiArthritis all platforms, email us at info@aiarthritis.org, and please support the show with a donation on our website! www.aiarthritis.org/donate.  Find all our projects at www.aiarthritis.org/initiatives and make sure to sign up FOR FREE (all stakeholders) to our AiArthritis Voices program to learn about all our opportunities to be at the table! www.aiarthritis.org/aiarthritisvoices   ________________________________________________________________ Patient Voices and All Other Stakeholders - Join our AiArthritis Voices Program and Connect to Opportunities to Have Your Voice Counted If you are a patient, a parent of a juvenile patient, or any other stakeholder (doctor, nurse, researcher, industry representative, or other health services person) - are you ready to join the conversation? It's your turn to pull up a seat. Join our new AiArthritis Voices program, where people living with AiArthritis diseases and other stakeholders who we need 'at the table' to solve problems that impact education, advocacy, and research sign up to have a voice in our initiatives. By signing up, you'll get notified of opportunities to be more involved with this show - including submitting post-episode comments and gaining insider information on future show topics. Patients and all other stakeholders are encouraged to join so we can match you with opportunities to pull up a seat and TOGETHER - as equals - solve the problems of today and tomorrow. JOIN TODAY! AiArthritis Voices 360 is produced by the International Foundation for Autoimmune and Autoinflammatory Arthritis. Visit us on the web at www.aiarthritis.org/talkshow. Find us on Twitter, Instagram, TikTok, or Facebook (@IFAiArthritis) or email us (podcast@aiarthritis.org).  Be sure to check out our top-rated show on Feedspot! 

Dave Jensen, W7DGJ, found his way into amateur radio from volunteering to help disabled Korean War veterans, who were active amateurs,  in a Cleveland, Ohio, Veterans Hospital.  From that interaction grew a love of radio and communications that has lasted a lifetime.  Dave likes to work CW on 17 meters and build his own equipment.  W7DGJ is my QSO Today.

David K Dunning is the new director of what will be one of the Top Ten VA hospitals in the country when the new medical tower comes online in early 2022. It will be one of my goals during 2022 to interview as many of the top VA Hospital Directors as I can to get their combined take on what is important to veterans' care.It is my hope that I will be able to talk with the leadership of each of the major VA centers in the year to come.  If you have suggestions please let me know.

In this two-part episode of Oncology, Etc., hosts Dr. Patrick Loehrer (Indiana University) and Dr. David Johnson (University of Texas) speak with Dr. Otis Brawley, a Bloomberg Distinguished Professor of Oncology at Johns Hopkins and former Executive Vice President of the American Cancer Society, about his incredible life and career. Subscribe: Apple Podcasts, Google Podcasts | Additional resources: education.asco.org | Contact Us Air Date: 9/7/2021   TRANSCRIPT SPEAKER: The purpose of this podcast is to educate and inform. This is not a substitute for medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. No mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. PAT LOEHER: Hi. I'm Pat Loeher. I'm director of the Centers of Global Oncology and Health Equity at Indiana University Melbourne and Bren Simon Cancer Center. DAVID JOHNSON: And good morning. I'm Dave Johnson. I'm professor of Internal Medicine Oncology at the University of Texas Southwestern in Dallas. We're really excited to be back with the second episode of our ASCO Educational Podcast Oncology, et cetera. And I don't know about you, but my arm's really sore from entering all the fan mail we got from the first episode. Either that or maybe it was that shingles shot I got last week I don't know. PAT LOEHER: No, I agree. I really appreciate Bev. Your wife just kept texting me how wonderful I was, and it was-- I enjoyed it. DAVID JOHNSON: Well, I'm glad you mentioned that, because I wanted to read this one fan mail. It says, dear, Dave. Thanks for carrying Pat [INAUDIBLE]. I don't know who that is, but I appreciate it. PAT LOEHER: Yeah, it works both ways. Works both ways. So what have you been reading lately, Dave? DAVID JOHNSON: Well, as you know, I love to read. And actually what I'm reading right now is The Howe dynasty by Julie Flavell. It's about the brothers Howe that were involved in the Revolutionary War. But the book I finished just prior to the one I'm reading now is Adam Grant's Think Again, which I really enjoyed. It made me think again. What about you? PAT LOEHER: How many times have you read the book by the way? DAVID JOHNSON: Again. Twice. PAT LOEHER: Think again. Yeah. There was the book that's called The One Thing. I know if you saw that book which I read a while back. It took me, like, a year to do it, because I just kept doing other things while I was reading it. I felt so guilty about it. I did read the book Caste recently, and it was on Oprah Winfrey's list. Barack Obama picked it. And actually read that on my way to Kenya a couple of months ago and found it very fascinating actually. You know, the notion of the juxtaposing of Nazi Germany, of the caste system in India, and the racial struggles that was going on here in this country. And I thought it was a very well written book. DAVID JOHNSON: Yeah. You mentioned that book to me, and I finished reading it a couple of weeks ago. I agree with you. I enjoy it very much. I learned a lot. We want to introduce today's guest. We're really, really fortunate to have with us today Dr. Otis Brawley. Dr. Brawley Is the Bloomberg Distinguished Professor of Oncology and Epidemiology at Johns Hopkins University. He's a graduate of the University of Chicago School of Medicine. He completed a residency in Internal Medicine at the University Hospitals in Cleveland Case Western Reserve and did a Fellowship in Medical Oncology at the National Cancer Institute, where he spent a good portion of his early career. In the 2000s, he relocated to Atlanta, where he became medical director of the Georgia Cancer Center for Excellence at Grady Memorial Hospital. One of the really most famous safety net hospitals in America. He was deputy director of Cancer Control at the Winship Cancer Institute of Emory University. And then he moved on to really a significant role. He became the chief medical and scientific officer and executive vise president of the American Cancer Society from 2007 to 2018, and we'll have a chance to perhaps query him about that. Currently, he leads a broad interdisciplinary research program on cancer health disparities at the Bloomberg School of Public Health and the Johns Hopkins Kimmel Cancer Center. Dr. Brawley has received innumerable awards. It would take the whole podcast to list them all. But among them are the American Medical Association Distinguished Service Award, University of Chicago Alumni of Professional Achievement Award, and-- one that I think is particularly poignant for ASCO members-- the Martin D. Abeloff Award for Excellence in Public Health and Cancer Control. In 2015, Dr. Brawley was elected to the National Academy of Medicine and well deserved. So just welcome to oncology, et cetera. Thank you so much for taking the time to be with us today. OTIS BRAWLEY: Thank you for having me. It's a pleasure to be with you and Pat. DAVID JOHNSON: Well, it's great to have you. I can tell you that. So let's just start with just a little background. Why don't you tell us about yourself? Where are you from? Where did you grow up? OTIS BRAWLEY: I grew up in Detroit. I grew up in one of the automobile worker neighborhoods, a blue collar neighborhood, and went to the Catholic schools there. The nuns in grade school pushed me toward the Jesuit school for high school, and the Jesuits in high school taught me how to think and really propelled me. And indeed much of my career, much of my writings, my philosophy toward medicine was really influenced by early education with the Jesuits. DAVID JOHNSON: Wow. PAT LOEHER: Hey, Otis. I just want to throw in-- in terms of books that we've read, one of the other books that I want to give a shout out is the book you wrote called How We Do Harm, which was really a wonderful book. I think it was several years in the making. Would love to hear how you made that. But I do-- while you're talking about your background, speak a little bit about Edward McKnight Brawley and Benjamin. OTIS BRAWLEY: Oh, OK. Benjamin Brawley was my grandfather's brother, and Edward McKnight Brawley was my grandfather's father. They're both ministers in the Methodist Church, the AME Church. Benjamin Brawley was dean of Morehouse College back in the 1920s, and he was the first Brawley to graduate from the University of Chicago. He got a PhD from the University of Chicago back during the 19-teens. And those are just a couple of my relatives. If you go to Morehouse, you'll find that the English building is Benjamin Brawley Hall, and Edward McKnight Brawley was his father and was a free Black back before the Civil War, and a minister before, during, and after. PAT LOEHER: Incredible legacy. Incredible legacy. DAVID JOHNSON: Those were your relatives from the South from the Georgia area? OTIS BRAWLEY: Well, my father grew up in Northwestern Alabama. An area called Leighton, Alabama. It's near Muscle Shoals. So those of us who remember the Beverly Hillbillies. My mother is from the middle of Arkansas. She's from Pine Bluff, Arkansas. And they met in Detroit. They were part of that northern migration in the early 20th century, where a large number of Blacks left the rural South and went up North to get jobs primarily in the industrial North. My father arrived there right after World War II. He served in World War II, got discharged, and went to Detroit. My mother actually went to Detroit really early on during World War II and worked in an airplane factory during the war. Then the two of them met. My father was a janitor at the Veterans Hospital in Detroit, and my mother worked in the cafeteria there. And that's how they met. They had my older sister, who was 8 years older than me, who became an attorney. And my younger sister was a certified public accountant. PAT LOEHER: What a remarkable story for your parents. And tell us a little bit about your journey to become a physician. How did that happen? OTIS BRAWLEY: It was very interesting. In high school, I was very talkative. I was very interested in policy. I did debate. It was very not a sciencey kind of person. In college, I became very interested in Chemistry and for much of College. I was going to go to graduate school in Chemistry. And luckily, when I was in college, I came under the influence of an infectious disease doc named Elliot Kieff. And he and I became very good friends. He was chief of infectious disease at the University of Chicago at that time. And over about two years, Elliott convinced me to drop the Chemistry thing and go to Medical school. And I applied to Medical school late, because I was so late in making that decision. I got into the University of Chicago and stayed there because my support system was there. And then in Medical school came across another gentleman. I've been very fortunate to have good mentorship and good people. They influenced me over the years. John Altman, who was one of the original medical oncologists back in the 1950s when there was arguments about how we should be staging people. Should there be four stages or three stages, and that sort of thing is when John really cut his teeth in Oncology. He became a great lymphoma doc. John took me under his wing while I was in Medical school, and pretty much open the world up to me, and explained to me how the world rotates in Medicine. And that heavily influenced me. Told me to go into Oncology because I still had an interest in Policy. And he said there's going to be a lot of policy in oncology in the future, and the best way to get involved with it is to get your credentials as a medical oncologist. And in many respects, I think in the early 1980s, John was thinking I was going to be chief medical officer of the American Cancer Society, which I obtained in 2007. PAT LOEHER: Wow. Yeah. We want to hear more about that. I just have to throw this in parenthetically that one of the things I did here is that I applied late to Medical school and got into the University of Chicago. I just wanted to know that I applied early, and there was a lesser known school in Chicago that sent me a rejection letter. And not only did they reject me, the last line of it says, good luck in whatever career you decide to go into, meaning that, if you can't get into our school, there's no way you'll be a physician. So I really admire you. DAVID JOHNSON: Yeah. I applied late too and-- PAT LOEHER: Got into Vanderbilt. DAVID JOHNSON: No. No. No, no. I didn't go to Vanderbilt. I only got into accepted to one medical school, and it was late. I was just like my career as a chief. And I was, like, the last person admitted to my class in med school. That's unbelievably interesting. Tell us, was John your influence to go to the NCI? Or what prompted you to choose the NCI for your medical oncology training? OTIS BRAWLEY: Actually, John was very influential in that decision. I told him I wanted to go into medical oncology when I was a resident in Cleveland. And he said, Otis, in his Austrian accent, I have been expecting this phone call. And he then told me where I was going to apply and gave me a list of nine places to apply. He told me I would get an interview at every one of those places. And as I was going place to place, I should rank them one, two, three, four. And so I called them with his ranking. And my first choice was not the National Cancer Institute. At which point he told me, if you go to that place, I will never speak to you again. PAT LOEHER: Oh wow. OTIS BRAWLEY: And I said, but you told me to go there to interview. He said, I wanted you to interview there, but I don't want you to train there. And I said, well, my first choice is the National Cancer Institute. And he said, fine. And a couple of days later, I got a phone call from the National Cancer Institute, and I got hired. And I will also tell you I called John up. And he says, Otis, I have been expecting this phone call. And then he said, now I want you to realize something. There is an old boys network, and your job is to get more Blacks and women into it. That's how you will thank me. PAT LOEHER: Wow. Wow. DAVID JOHNSON: So you were at the NCI at a period of time where many people would say it was the heyday of the NCI. I think it's still the heyday now, but tell us about your experiences there. What was it like? OTIS BRAWLEY: It was fascinating. It was when Vince DeVita was still the director. I was there for the transition. Eli Glatstein was the chair of Radiation Oncology. It was an amazing group of people. Dan Longo was there doing lymphoma. Marc Lippman was still there doing breast. It was just an amazing group of people when I applied, and interviewed, and when I first got there. And there was still a lot of excitement. We were still heavily involved in chemotherapy. Of course, I was up on the 12th and 13th floor building 10. Down on the second and third floor was Dr. Rosenberg doing his immunotherapy work, which of course, has now paid off dramatically. Some of the old monoclonal antibody work that led to a number of wonderful drugs was being started at that time in the mid to late 1980s. And so it was still a very, very exciting time at the National Cancer Institute. And in many respects, we were still on that burst of optimism that started with Nixon's war on cancer in 1971. It was still felt almost 20 years later at the National Cancer Institute. DAVID JOHNSON: And you linked up with an old friend of mine from the old Southeast Cancer City, a gentleman by the name of Barry Kramer? OTIS BRAWLEY: Yes. DAVID JOHNSON: What a wonderful relationship. So how influential was Barry in your involvement? OTIS BRAWLEY: Barry was incredibly influential. As I said, I have been very fortunate that along the way I have come under the influence of some amazing physicians, and I've had amazing mentorship. And that's actually, I think, important for all of us in oncology. Barry and I got to work together for quite a long while. Barry influenced me and literally taught me epidemiology. Got me some major opportunities at the National Cancer Institute and really was influential in promoting me and boosting my career. PAT LOEHER: I want to move you a little bit longer in your career and talk about the ACS and a little bit your experience there, Otis. And then with that, actually, maybe the secondary question is, a commentary on the leaders over the years that you have had-- the aspects of good things about leadership and the poor things. And obviously, you have certainly much to share on that. OTIS BRAWLEY: Yeah. Well, as I devote my career at the National Cancer Institute, I went to the Division of Cancer Prevention and Control. Under Barry, learned a lot of epidemiology, and learned a lot about screening, learned a lot about treatment outcomes, got very involved with some of the disparities or minority health issues. And then I was very fortunate to be detailed to work in the surgeon general's office and work with David Satcher when he was surgeon general. He's the one who started using the words, health disparities. Prior to that, we called it minority health or special populations. He used health disparities. And I was able to use some of my epidemiologic talents to develop some of those arguments using science to show. And actually some of the things that we had to show, believe it or not, was we had to show that equal treatment yields equal outcome amongst equal patients, because a lot of people, especially the politicians we need to deal with, were really hung up. And we still see this to this day that people are hung up that Black biology is different from white biology. Even in breast cancer today I hear that even though I like to point out there are now six states where the Black death rate for breast cancer is the same as the white death rate for breast cancer. And there are 12 states in the United States where white women have a higher risk of death from breast cancer than Black women in Massachusetts. But anyway, we got into this biology thing. And so I was very fortunate again to work for David Satcher and had some exposure to Tuskegee syphilis trial and the president's apology for that. So I was really involved with a number of things. And then the Jesuits still back there-- always think, always be contemplative, always reflect on what you're doing, always question what you're doing. Father Pawlikowski's maxims, which Dick Cheney sort of preferred is a few years later. And that is there are things you know, things you don't know, things you believe. Question what you know more so than anything else. And so that's really how I develop my concerns about orthodox use of Medicine. And using the science and applying it in a very Orthodox way, I started realizing that a lot of the disparities were due to wasted resources with people being non-scientific especially in the era of the 1990s, where everybody was doing prostate cancer screening, and there was not a single trial to show that prostate cancer screening saved lives. Yet all the resources were going into that, and people were literally-- I was able to go to various safety net hospitals and see all the resources being diverted away. People would shut down cervical cancer screening programs to do prostate cancer, which just didn't make sense. So I got very interested in how you practice medicine. Went to the Emory in 2001, because I wanted some practical experience outside of government. And had a wonderful opportunity to go there. Work at Emory. Work at one of the largest safety net hospitals in the country. Learn a little bit about the practical application of Medicine and some of the problems that people at safety net hospitals encounter. Worked with the School of Public Health and folks who did health education to learn how to convey messages. And then I was very fortunate. You know, the American Cancer Society is right down the street from Emory University. And I had met the chief medical officer of the American Cancer Society, Harmon Eyre, back in the 1990s when I was at the National Cancer Institute. And again this sort of mentoring thing comes up again. Harmon called me up one morning and said, why don't we go to lunch? And so we went to one of the student cafeterias at Emory and had lunch. And he essentially said, you know, I'm 67 years old. I've had this job for 20 years. I'm tired of it. Why don't you take it? PAT LOEHER: Wow. OTIS BRAWLEY: And so I applied to be chief medical officer of the American Cancer Society and got to know John Safran, who, at that time, was the CEO, who was a wonderful man with incredible vision. Again, this mentorship thing comes up again. PAT LOEHER: Well, Dave we had a lot of information here. We're going to carry this over. This concludes the first part of our two-part interview with Dr. Brawley. And our next episode will air on October 5. We'll talk a little bit more about Dr. Brawley's life experiences and particularly his work with the American Cancer Society NCI. He's been an incredible individual, and we look forward to finishing up this conversation. Thank you to all our listeners for tuning in to Oncology Et Cetera an ASCO Education Podcast, where we'll talk about anything and everything. If you happen to have an idea for a topic or guest you'd like to see on the show, please email us at education@ASCO.org. Thanks again. And remember Dave has a face for podcast. SPEAKER: Thank you for listening to this week's episode of the ASCO eLearning weekly podcast. To make us part of your weekly routine, click Subscribe. Let us know what you think by leaving a review. For more information, visit the comprehensive e-learning center at elearning.asco.org.

 |A prosthetic device is any device that helps replace, correct, or support a body part or the function of a body part. In the VA that definition gets stretched a bit to cover so much more. It can be, according to Asst. Chief Walker, the proper socks for a diabetic patient all the way up to the retrofitting of a car to provide a vet with mobility. Listen in and you will learn, just as I did, the multitude of services that the VA provides.

Dr. Katie Strong, Assistant Professor in the Department of Communication Sciences and Disorders at Central Michigan University, talks with Rochelle Cohen-Schneider from the Aphasia Institute about the importance of developing and attending to our clinical selves. Rochelle Cohen-Schneider is the Director of Clinical and Educational Services at the Aphasia Institute in Toronto, Canada. She has worked in the field of aphasia (across the continuum of care) for most of her career spanning 38 years. She studied Speech and Hearing Therapy in South Africa and completed a master's degree in Adult Education in Toronto. In addition to her interests in clinical education, continuing education and working within a social model of aphasia Rochelle is passionate about understanding ‘how clinicians think, and why they do what they do.' In this episode you will:  Hear stories about clinicians connect the dots in the things you can't see as a clinician but have a critical role in the work you do. Understand the difference between reflective and reflexive work, and why both are essential to developing our clinical selves. Learn a few tips and some resources to broaden and deepen your clinical lens. KS: Rochelle, welcome to this episode of the Aphasia Access Conversations Podcast. I'm so excited for you to be here today, and to have this conversation and for our listeners to really hear about your work and perspectives. RCS: Thank you very much for this invitation, Katie, I'm really looking forward to digging into this topic with you. Thank you. KS: Oh, me too. I'm just so excited. And as we get started, Rochelle, I'd love for our listeners to hear a bit about your story and how you became interested in this area of the ‘clinical self'. That's powerful, that's powerful Rochelle. I mean I Wow. RCS: So, Katie, it became clear to me that the therapeutic encounter was a multi-dimensional endeavor requiring multiple skill sets, right from the days of being a student in, as you said earlier, in Johannesburg, South Africa. So, the physical structure of what was known as the Speech and Hearing Therapy Department housed both lecture halls, and small clinic rooms, where we, the student clinicians, carried out our therapy activities under the watchful eyes of our clinical tutors. These tutors watched from behind one-way mirrors and spent a lot of time debriefing with us about the session, our goals, the treatment methods, we chose, why we chose them, how we performed, and also how we enacted our clinical selves. In other words, how we related to our patients, where we sat, why we sat where we set, and we will often put through the paces to have us begin to understand how we positioned ourselves as clinicians. And it was really important in the clinical setting and how we learned to be, the relationship and relating to the clients was really, really important. And in fact, when we wrote our reports for our tutors, the first goal, regardless of age, or communication disorder, had to be establishing rapport. And actually, as the literature tells us rapport is actually only one small element within the clinical relationship. Maybe it's a gateway. It's a fairly static notion, because the relationship is much more dynamic, you know, interactive and an unscripted interaction. So because of the way this physical physically was set up, our academic and our clinical learning took place under the same roof, allowing for a very dynamic and stimulating learning environment, which focused both on rigorous academic growth and clinical development. So as a clinician stepping into the role of a clinician. And I think I might be able to say that this environment really helped us student clinicians “think with theory”, as Felicity Bright calls it. And we were trained to understand both the objective and subjective aspects of being a clinician and that fully engaging in a therapeutic encounter is really important. Another little aspect of this was in our third year of training in a four-year Honors Program, the clinical load was divided over four years and kind of matched what we were learning in those lecture halls. In the third year, we were observed by one of the professors from the psychology department. We had a couple of observations, and his job was simply to observe our therapeutic interactions, and how we engaged with the clients. And he obviously was not able to comment on the content of the therapy session because he had no idea. But he again, like our tutors, but even more rigorously asked us lots of questions around our positionality, both the physical and conceptual positionality, and all kinds of really very difficult and grueling questions. When I interviewed for the job at the Aphasia Institute, and I was interviewed by my boss, Dr. Aura Kagan, she asked me to tell her a little bit about what my day involved. That was one of the interview questions. I told her about the fact that I had to go, unlike the other professions, the physiotherapists who seem to have their own porter, me as a speech pathologist, had to porter my own patients or clients and I brought my clients into my room, and I started therapy. And she said, “Okay, no, no. Go one step down. Tell me more. What did you talk about when you were bringing the patient down?” Now, obviously, the patient was forward facing, and I was behind. But she was interested in the topics that I would think to talk about. And so, you know, we talked about what happened last night? Did you have any visitors? Did you watch TV? How's the food?  Anything else you want to say? And then I would get my office, I would wheel the client in, and then I had a ritual. I didn't realize it was a ritual. But I leaned over, and I put my white coat on. And that signaled to me, the clinician, that the personal self is out the door, and now I am the professional, I am the clinician.  KS: That's powerful, Rochelle. I mean, wow! RCS: And she said to me, “Okay, so what's the difference?” and she probed, and I started having the beginnings of the understanding of pulling together the personal self and the professional self, that maybe then becomes the clinical self. And this very clear demarcation fell away completely when I joined the Aphasia Institute, where there were no white coats, and there were almost no doors. And so, we worked in open spaces. And obviously, there of course, were times when doors and private spaces were called for. But I suddenly had this dawning realization that, you know, a couple of years, seven, eight years into my career, I had never, ever watched another clinician work. And here I was suddenly watching these brilliant clinicians work, and I wanted what they had. And so that set me on my journey. And, and just being very, very interested in how to develop that part of myself, that would engage our clients in a life participation model. KS: That is such a journey and I so appreciate you sharing that with us. You know some big ‘aha moments' about who we are as clinicians and how that changes or doesn't change based on who we're interacting with. I'm so excited to talk more about this. I'd like to first talk about an article that you co-authored a clinical focus article in the 2020 ASHA perspectives journal titled Spotlight on the Clinician in the Life Participation Approach to Aphasia, Balancing Relationship-Centered Care and Professionalism. Could you tell us a little bit about how this article came to be? RCS: Katie, before I tell you that I just want to...thinking about and talking with you, I've kind of connected many, many dots. And the dots are some are visual dots, some are auditory, some have cognitive, some are emotional dots. And so, one of the things that dawned on me, when I used to read to my children, there is a well-known book here in Canada called Something from Nothing. And it tells a story of a little boy whose grandfather is a tailor. And the grandfather makes the grandson a jacket. And of course, with each passing year, as the boy grows, the grandfather has to refashion the garment. It becomes a vest, then a tie and finally, the fabric simply covers the button. As the grandfather is snipping away, pieces of the fabric are falling through the floorboards. And unbeknownst to them, there is a little family of mice who live under the floorboards. And they're getting all these pieces of fabric. And they are designing and furnishing their house with this with this fabric. The minute I saw this image, I said to myself, that is what interests me. It's everything that we don't see. The mouses house was about one eighth of the page, (of the book). It was a fairly big book. And to me, that was the clinical encounter underneath. And when working with social workers for many, many years, I thought that that's where they worked, in the things that you can't see. And again, I wanted to go there.  KS: Wow! RCS: After the over many years of working together with Aura, we had spoken so much about the value of working with social workers and our learnings and how we really feel so privileged to have social workers by our side for so many different reasons. And one year at an Aphasia Access Summit, Aura heard Denise McCall and Ann Abrahamson, SLP and social worker respectively, from SCALE, The Snyder Center for Aphasia Life Enhancement in Baltimore. And she heard them give a talk about what they call ‘the dance', how they learned to work together, despite having such disparate perspectives. Denise actually bravely talked about what got in the way and how the speech pathology lens got in the way of the in the way of a satisfactory client encounter. And Aura came back to me and she said, “You know what, you've got to reach out to Denise and Ann because they think like you think.” And so that's kind of where it started. But also, in my quest to understand the nuts and bolts of how we do our job, I have also explored how my colleagues work and what they know about how they work. What I understand as their deep tacit knowledge. KS: What they know about how they work, that's deep.  RCS: That's what I'm constantly trying to understand. We don't spend a lot of time articulating what it is we know and why we do what we do. We spend a lot of time talking about the evidence-based approaches and absolutely we should. We should totally give as much time and attention to that as possible. But there's this whole, rich, rich source of information and rich source of data that we're all generating every single day as we interact with clients. And the literature tells us that these kinds of things are really, really important in understanding and dealing with because it makes us more effective. Clinicians offering evidence-based models, treatment services, assessments, etc.  KS: We are an ingredient to the therapeutic interaction.  RCS: Absolutely, absolutely. Many years ago, I read a research article, and I cannot remember exactly what it wasn't it, I think it was possibly not even our field. But the title of the research article was Hardening the Soft Data, which I think those of us and those of you who are involved in qualitative research are totally engaged with. But to me that really spoke to trying to take this whole, the subjective part of the relationship and trying to see exactly what it is. And so that sort of set me on the path with this article.  KS: That's great. So, the focus of the article is about relationship-centered care, and you co-authored it with colleagues, Denise from SCALE and social workers and speech pathologists.  It's really about relationship-centered care. I was hoping you could talk with our listeners about this approach to care and why it really is essential for our work as clinicians who embrace the Life Participation Approach to Aphasia. RCS: Yeah. In the article, the first vignette that I bring forward is the contribution of Denise, and Ann where they tell this story of a session, where they were working collaboratively with a client. The session by their account, did not go well. And as I mentioned earlier, Denise very bravely explains why in her opinion, it didn't go well. And she says, the speech language pathologist changed the subject, and ignored the social workers cues to continue the conversation. And so, a key opportunity was missed. And I thought so much about all of our missed opportunities, where we just don't have the lens to catch things that we don't see. So, they continue their story and tell us that they debriefed and obviously have a trusting relationship with each other. The interprofessional collaboration was enriched by that discussion. They go back and they resolve the issue. And it was a serious issue. It was a family secret that the client was carrying. And so of course, made me think about all the secrets that our clients carry. And what if you don't have a social worker to work with you? And so those of us who do are really, really, really fortunate. I think the contribution of social workers is significant. I think they inherently and as part of the learning, are engaged with learning about the therapeutic relationship, and also the tensions that arise from that, around professionalism and boundaries. And of course, their scope of practice naturally includes gathering information about goals, roles and interactions among family members and within social network. They are also interested in learning about clients and families before the health incident that caused the aphasia and of course, the impacts. So social workers de facto have always had a broader clinical gaze than we have. But of course, now with the Life Participation Approach, the model and the model of the A-FROM (Framework for Outcome Measurement in Aphasia), the model that Aura Kagan and a bunch of her colleagues have created. So, I think with these models we are catching up. And we are broadening our gaze and considering many, many more domains for our intervention. I think as we continue to understand the impact of aphasia, on all aspects of the client's life, we have no choice but to go there. And I think also in terms of the Life Participation Approach to Aphasia, which clearly puts the client at the center of the clinical endeavor, we've had to do our own dance, I guess. This again makes me think about Felicity Bright, drawing from sociology. She talks about our positionality in the therapeutic encounter and so we are no longer the expert. We are the expert guide, but the client is the expert of themselves. I'm not in a university setting, so I don't exactly know how students are being taught. I would imagine is such a tension between trying to teach the scope of our professional responsibilities and expertise, that I don't know exactly what's being taught. We need to shift these positions and to be open to partnering more with a client. I think we have to really follow and pay attention to the relay, a relationship-centered care framework. And Linda Worrell talks about this incredibly eloquently. She bases the work on the model that was developed for physicians. And, you know, talking about the fact that we as therapists, and our patients bring full dimensions of ourselves as people into the relationship. Thinking backward Aura challenged me, “You know, you can't leave yourself out the door, you came with yourself, even if you had to mark that moment when you transitioned, you came with yourself.” And so, as we are delving into clients lives and our position of power is changing, and we're opening ourselves to interrogating ourselves in a sense, based on how the clinical encounter proceeds. KS: Yeah. I love the thought of the broadening of the gaze. And your point to training clinicians, I think it's something that we really need to start paying attention to, early in the development. Just like you were sharing about your story with your own training and having someone be able to help you talk about, “Why are you sitting where you're sitting? Or  Why are you sharing with this? Or when this happened, by saying this, you shut, you shut the door or shut someone down about something that was very important to them.” I think it's, you know, really essential. I feel like, historically, we've ignored it or just expected that to happen after you get your knowledge about evidence-based practice knowledge. And I really feel like we need to be better at helping our students that were training into the field, to do such beautiful work to be able to develop themselves early on, so that they're able to better serve their clients and themselves really.  RCS: Yeah, yeah, absolutely. You know, one year I was at ASHA, and I went to a really powerful presentation, by the late Shirley Morganstein. And I looked around the hall. It was such a brilliant presentation. And I saw just older clinicians there. To your point, Katie, of, you know, you first learned this, and then you learn that. After the presentation, I went up to Shirley and we chatted, and there were a couple of other people standing around and just to your point of trying to get this in as early as possible. Kind of braiding it together the subjective and the objective. And just building that awareness, because the subjective enables the stronger version of the objective. KS: Absolutely. I think we've got work to do in that. I know you've been a guest speaker in the course that I teach. I've been fortunate to develop an elective called The Engaged Clinician: Our Behavior Matters. I think I've taught it for three or four years now. It's kind of viewed as a special time to be able to focus on that. And I think what's sad is that it shouldn't be special. It should be an integral part of how we train our workforce, our clinicians.  RCS: Yeah. And I think we're lucky that we are seeing a not a resurgence, but an emergence of interest. And we're seeing it from people who are thought leaders in our field and, you know, sort of narrower area. And so I think, it'll roll around. There's some really, there's some really amazing and powerful work being done right at the moment, which is exciting. KS: Absolutely. You mentioned earlier one of the vignettes. The article that you co-authored has six vignettes that provide examples of how SLPs navigated clinician-client boundaries. It's a fabulous article, it really is. I was wondering if you could pick one more to walk us through another vignette just to give us a flavor for the article. RCS: Sure, thank you. One of the exciting things is, some of these vignettes have been floating around in my brain for a while because I've, as I mentioned earlier, kind of after some of my colleagues. Each time I come back to them, I see something else, which is really enriching for me. And again, thinking about this talk today has given me some additional perspective. So. I will take you through one, and it's been Vignette #5. I titled all the vignettes, together with my second co-author, Melody Chan. We titled them to sort of give some clues. So, this is called Recognition as Relating. I'll just quickly read a small segment of this.  The SLP says, “the client was quite reserved, and he began telling me about his job. I could see that he took a lot of pride in it. And when I reflected that back to him, I said to him, ‘You're, quite a perfectionist.' He broke down and he cried. It was quite a moment because it was just one word.”  And as I think about this tiny little window into a clinical encounter, there is so much richness here. The client she was talking about an assessment encounter. She had just met the client for the very first time. It was not a long-standing relationship, and she recounts this piece that what had happened sort of at the beginning of the session is he had walked into the room, and he'd noted that the picture. There was a picture that was crooked. And so, he either commented, or he kind of adjusted it, I can't remember. And so, she was starting to form a picture in her mind. So, I think what happened was, it wasn't just one word. It was the fact that she's saw into this man. She saw into his identity, and she recognized who he thought he is. Who he is, his essential self. And I think what a moment for a person with aphasia, was had their whole life quickly, suddenly up ended by a very traumatic event. And his identity has sort of been shattered as well and stolen and all the words that that we use when we talk about identity. And here is somebody who he has never met. And she says, “I see you”. And that is incredibly powerful. And I think that my new reflection on this is that at that moment, the clinician must have been golden for him. Of course, I wasn't there. But I imagined that the level of engagement and connectivity must have spiked significantly. And so, I really have learned a huge amount from the work of Felicity Bright, and I'll talk about that in a little bit. But co-constructing engagement between a client and clinician is a relational act, it's happening with you pay attention to it or not, it's happening. The fabric is falling under the ground, it's happening. You're not seeing it. We're not seeing it. And so ultimately, the more engaged and connected a clinical encounter feels for the patient, the more positive the patient experience is, which leads to all kinds of positive foundational elements that allow a clinical encounter to be successful, and a therapy session to be successful, and a treatment approach to be successful. And so, for me in this vignette in this anecdote, the clinician is primed to look for identity. She knows how important this is. It didn't take any time. It took no time whatsoever. She still completed the assessment in the required amount of time. But that one thing, just hit the ball out of the park. It's such a powerful story to me. KS: It is what it is to me too. I'm a little teary and I've read the article before. But it you know, that's, you know what we're talking about. And not every session has to have that amount of power, but those little instances where they happen, weave together this stronger relationship where you're more willing and able to work collaboratively together, because there's this respect and trust.  RCS: Yeah.  KS: Thank you. Well, thinking about the critical incidents like the one you just walked us through with that vignette is really an integral part of developing who we are as clinicians or our clinical selves. And I know you've read a lot and examined this quite a bit in your experience, and particularly in your expertise in adult education. And I was hoping you could share a few tips for our listeners, who might be ready to expand their reflective practice. RCS: Absolutely, Katie. So, I think that the Master's in Adult Education was a direction that I really never thought that I would go. I had always thought that I would be interested in going back for either social work or psychology. I always had a deep interest in counseling. I think many of us who've ended up in this particular subset of a subset of a subset or subfield, many of us have this interest. But I was asked many years ago by a one different social work and speech pathology team to videotape a session that they were running with two couples were both in both instances, it was the husband who had had aphasia, they were doing a counseling, training kind of session. And so, sitting behind the camera, it became clear to me that I wanted to pursue what I'd always thought about, you know, you've heard that the seed from the very beginning, the whys and the hows of the clinical doing. It was clear, I didn't want to be the social worker, but I wanted to know what the social worker was thinking. And so somehow, I found my way to adult ed, and I think it served me really well. There was a lot of learning in something outside of our field, but certainly the, the field of teaching and learning, and education and pedagogy and teachers, and nurses really do a lot of self-examination. And so, there's been a lot of kind of building of theoretical models and thinking around what can help teachers and various other professionals look into this whole endeavor, or whether it be a clinical endeavor or a pedagogic endeavor. And so, I think one of the key things that I learned that I had to sort of sum up. There were two main areas, but I'll talk about what you've just raised, the reflective, is kind of thinking a little bit about both the reflective and the reflexive ideas. So reflective, to me is something that we tend to do afterwards. We reflect on how the session went. We pull things apart. And it's extremely valuable because it builds all kinds of muscles and lenses. But I think what became really clear to me, and what was really interesting was thinking about being reflexive, which would be in the moment of things happening, being able to identify it. And we don't always talk about that in our field. In in nursing there's a nurse educator called Patricia Benner and she talks about going from novice to expert. And I think that probably for those of us in the academy, that those are concepts that are well known to you. But we don't always talk about it out in the field. And so, reflexive is being able to make those tweaks as you go along. And, of course, that is what, whether you in the academy, or we're whether you're a field supervisor as I have been, it's what we're teaching our students. You know, make the adjustments as you go. Sometimes you can, and sometimes you can't, but look for them and see them. And then under being reflexive is critical reflexivity, which is understanding all about yourself, and how that impacts your environment. And so I think those were really, really key learning issues. And I just want to, I want to just take advantage of your question, Katie, if I may, and just go through one of the other vignettes that sort of demonstrates kind of reflexivity.  So, the clinician says, “I was scheduled for an assessment. And when I prepped and read the chart, I saw the client was a gentleman in his late 70s, early 80s. And I had an oh moment as I realized that this client was born in Germany, and that my own grandmother had survived the Holocaust. I did have a bit of a personal reaction to his potential life situation at that time, so I had to check myself in the moment, aka do a little moment of reflexivity. And I had to make sure that I wasn't showing the reaction to the client.” And the clinician realizes that having been attuned to her critical reflexivity, she says, “I guess in that moment, it was a point of growth. Because I didn't think that early on in my career, I would have been able to have that self-talk in my head, and still be able to carry on with the assessment.” So, I think, you know, she caught herself, she had that little conversation with yourself in that moment. It was a real moment of reflexivity. And I would imagine, I never have asked her that she's added that to her toolbox of critical reflexivity. And she now knows that about yourself a) what triggers her and b) what she can do about it. So, I think that was the big learning from adult age.  KS: And you know, that's just so important because, you know, we haven't really talked about this at all today and didn't really plan on it, but the aspect of stress levels and burnout and you know, taking care of ourselves as clinicians and, this work of reflection and reflexivity is helpful in helping us to navigate the really intense experiences that happen when you're living a clinical life. RCS: Yeah. Yeah. And there is I won't read the vignette, but the last vignette in the article is about is a clinician telling a story of how negative how negatively a client impacted her, because he embodied all the things that ran counter to her values of how she lived her life. And this tension of, you know, duty of care and intense dislike of somebody. And I think what we drew as a collective as our team from that, is there has to be a safe place. Back to your point about stress and burnout, there has to be a safe place that a clinician can come and say, I cannot work with this gentleman. Who does he not trigger? And if he does not trigger you, could you please be the one? And that's actually what we did. So, this is making time for reflection and reflexive talk, and is really important butt it has to be in a safe environment for clinicians. Yeah.  KS: Well, so, you know, I think most of us think about things like journaling or talking with colleagues. Not complaining with colleagues, but debriefing and really sharing about, where you were, where you were at, and what you were thinking and how you're feeling currently, you know, are really vital parts of our job. What are some of your top resources that you would recommend for someone who wanted to explore into this area? RCS: Yeah. Yeah, absolutely. So, I'll break him down into two major categories. The first one, I will just run off a couple of names within our field, whose work is so inspirational and so groundbreaking and continues to break ground, even if they've been saying and talking these thoughts for many, many years. So, I'm going to start there. I do have to talk about the impact that my boss Aura Kagan has had on me, and Nina Simmons-Mackie, Audrey Holland's work from being a student in South Africa was absolutely (inspiring). Discovering and falling upon this work, and this reading was just, you know, an absolute godsend. It felt like an oasis in a desert sometimes. So Audrey Highland, Jackie Hinckley's work, and Linda Worrall's work. Felicity Bright's' work. And Martha Taylor Sarno's work. I don't know if people have read and if it even possible to get hold of a lecture she once did called the James Hemphill Lecture or award or something that. These works just helped to open up an additional lens and an additional dimension. So those are people in our field. And Katie, classes like yours are also groundbreaking for clinicians to, as you said, to be learning early on. So those are really, really inspiring.  In terms of stepping out of our field, an area that has been extremely important and influential for me, is the area of Narrative Medicine, in all of its forms. And a lot of medical schools are starting to adopt the principles. Narrative Medicine comes out of the medical humanities. It involves using the arts to help clinicians see and think and develop what's called narrative competence. I'll give a shout out to a group of clinicians in Toronto who are using a Narrative Medicine framework for some student training. And we at the Aphasia Institute have jumped on board as they've allowed us into join them. This is very, very powerful in helping students write and tell stories from the perspective of the client. Very, very important. There so there are Narrative Medicine courses. The Narrative Medicine, Columbia, runs an incredible Narrative Medicine course and Jackie Hinkley will back meet up. We found each other at the course many, many years ago.  KS: Oh, that's fabulous! RCS: So, that that would be a strong recommendation, then on Twitter. And I do see sometimes speech pathologists, and whatever we do with Twitter. It's the handle the hashtag is #medhumchat. And it's sometimes worth just scrolling through there to get just great thoughts and ideas. I omitted to mention all of the clinicians who are part of that original Life Participation Approach to Aphasia core group, any of them and their work is really instrumental in in moving us forward in this domain. And finally, looking outside of the field into the field of maybe social work for courses. I was very fortunate to be able to take a two-year externship in family therapy. And the clinician is, well there's no way to hide in that field. And so, there's a lot of things that I learned and I'm thinking about it from there. And so, again, encouraging people to look outside of the field for any education.  KS: Thank you. I know you sent a list of some favorite reads and so we will have reference citations and some links in the show notes. We'll make sure to put the med hum chats hashtag in there also. So be sure to check out the show notes if you're listening and you're wanting to dig a little bit deeper into this. Rochelle, any thoughts that you'd like to share as we start to wrap up this conversation today? RCS: Yes, I'd like to just share just two final thoughts. The one is what you actually had said, Katie, you know, they are all these great resources out there, but there are a lot of things that clinicians maybe can do locally, in their own departments. And so, you know, not complaining, you said by talking about, both for the purpose of de-stressing, and for the purpose of deepening, and building lenses and muscles. One of my biggest learning opportunities, and I mentioned it early, has been to see and watch and hear and feel my colleagues working. I don't know if that's possible for people to do. You don't have to do it often, just once asked if you would be permitted to sit in and watch a session where you work, you know. You both see the same thing. And ideally, of course, like we do with students, sometimes if you can record it, but I know there are issues of time and privacy, those do get in the way. But at least looking for sort of things that are in place already, that you can just think about different topics. So, if there is a journal club, or case discussions, once in a while just shifting the focus onto some of these. Remembering the image of the mice underneath just to the tiny little piece, the liminal space underneath there, I think it could be really helpful. And I just am going to end off with a story. And a resource that I did not mention, Cheryl Mattingly, who is an anthropologist, who has watched occupational therapists, and I am not exactly sure how that came to be. But there's an incredible vignette that she tells, and I don't have the book because it's sitting in my office, and we're not yet back on site. But it's the story goes something like she observed a young occupational therapist, doing a session with a group of older gentlemen, possibly in a Veterans Hospital. And when she walked in, the gentlemen were, you know, they were in wheelchairs, they were hunched over, they were drooling, listing to one side. And the girl, the occupational therapist came in the clinician came in, and she sort of sat down. It took her a minute, and then she looked out the window, and she said, “isn't it you know a glorious day? “And then she said, “Oh, I'm really excited about my vegetable garden or something.” And I sort of get goose bumps. Katie, you had tears. And I've read this a million times. But suddenly, Cheryl Mattingly says these gentlemen sat up, stop drooling, paid attention, looked at the clinician, and she could imagine them in the gardens with a bottle of beer, leaning over digging into the beds, and it became a very animated discussion. And then she says, and then something happened, and the occupational therapist said, “Okay, now let's get to our task.” And whatever the task was, it was the most boring, soul-destroying task. And these men, that she had enlivened, and awakened, suddenly just became, like they were in the beginning. It's a beautifully rendered piece that she writes, and she said, she was just heartbroken. She was heartbroken for the men, but she was also heartbroken for the clinician, because she missed such an opportunity. And so, I would just encourage us to, you know, look for the opportunity look for the buddy, the buddy colleague who might have the same lens as you and build on that together and hopefully impact everybody around you.  KS: Thank you, Rochelle, this has really been a delightful conversation. So much to think about. And you inspired me, and I know our listeners will be thinking more about the important role that we have as clinicians as people as persons as in contributing to this thing we call therapy. So, thank you so much. It's been great to have you on the show.  RCS: Thank you so much, Katie. And thank you for your work.   On behalf of Aphasia Access, we thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access and to access our growing library of materials go to www.aphasiaaccess.org If you have an idea for a future podcast topic email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Websites and Social Media Aphasia Institute  https://www.aphasia.ca/   Aphasia Institute on Twitter @Aphasia_Inst    Links Mentioned in Episode Boundaries and Clinical Self Readings Cohen-Schneider, R., Chan, M. T., McCall, D., Tedesco, A. M., & Abramson, A. P. (2020). Spotlight on the clinician in the Life Participation Approach to Aphasia: Balancing relationship-centered care and professionalism. Perspectives of the ASHA Special Interest Groups, 5, 414-424. https://doi.org/10.1044/2019_PERSP-19-00025  Duchan, J. F., & Byng, S. (Eds.). (2004). Challenging aphasia therapies: broadening the discourse and extending the boundaries. Hove, East Sussex: Psychology Press. Penn, C. (2004). Context, culture, and conversation. In Challenging Aphasia Therapies (pp. 83-100). New York, NY: Psychology Press. Sherratt, S., & Hersh, D. (2010). “You feel like family…”: Professional boundaries and social model aphasia groups. International Journal of Speech-Language Pathology, 12(2), 152-161. doi:10.3109/17549500903521806 Walters, H. B. (2008, Fall). An Introduction to the Use of Self in Field Placement. In The New Social Worker: The Social Work Careers Magazine. Retrieved July 26, 2019 from https://www.socialworker.com/feature-articles/field-placement/An_Introduction_to_Use_of_Self_in_Field_Placement/  Kagan, A. (2011). A-FROM in action at the Aphasia Institute. Seminars in Speech and Language, 32(3), 216-228. doi:10.1055/s-0031-1286176   Clinical Engagement Readings Bright, F. A., Kayes, N. M., Cummins, C., Worrall, L. M., & McPherson, K. M. (2017). Co-constructing engagement in stroke rehabilitation: a qualitative study exploring how practitioner engagement can influence patient engagement. Clinical rehabilitation, 31(10), 1396-1405. doi: 10.1177/0269215517694678 Bright, F. A., Kayes, N. M., Worrall, L., & McPherson, K. M. (2015). A conceptual review of engagement in healthcare and rehabilitation. Disability and Rehabilitation, 37(8), 643-654. doi:10.3109/09638288.2014.933899   Kayes, N.M., Mudge, S., Bright, F.A.S., McPherson, K. (2015). Whose behavior matters? Rethinking practitioner behavior and its influence on rehabilitation outcomes. In K. McPherson, B.E. Gibson, & A. Leplege (Eds.), Rethinking Rehabilitation Theory and Practice (pp.249-271). Boca Raton: CRC Press, Taylor & Francis. Worrall, L., Davidson, B., Hersh, D., Howe, T., Sherratt, S., & Ferguson, A. (2010). The evidence for relationship-centred practice in aphasia rehabilitation. Journal of Interactional Research in Communication Disorders,1(2), 277-300. doi:10.1558/jircd.v1i2.277 Narrative Medicine Readings Charon, R. (2008) Honoring the Stories of Illness Oxford University Press. New York Hinckley, J. H. (2008). Narrative-based practice in speech-language pathology: Stories of a clinical life. San Diego, CA: Plural Publishing Inc. Medical Humanities Chat on Twitter @MedHumChat   #medhumchat

The Director of the James A Haley Veterans Hospital has been a frequent guest on Veterans Corner Radio since its inception over four years ago. Joe's transparent management style has allowed for almost all of the top managers at that facility to come on Veterans Corner Radio and share information with our listeners. But beyond that transparency, Joe has established a culture of competency at the hospital that most of us have never seen before. Tune in to hear him share the wisdom he has gleaned for 38 years with the VHA and how the implementation of that knowledge has created a workforce dedicated to serving veterans. 

Episode 95: Gut Health with Dasha Agoulnik, RD Today we invited Dasha Agoulnik, RD and owner of Core Perform to the show and asked her 9 of our hardest questions pertaining to gut health. We covered methylation, SIFO vs SIBO, candida, thrush, and yeast infections, troubleshooting constipation, the Herxhiemer reaction and more! Dasha attended Tufts University in Massachusetts where she studied nutritional epidemiology before completing her dietitic internship at the Veterans Hospital in Tampa, FL.

Upfront May 26, 2021 Guest Director Of The Veterans Hospital & Health Service Larry Connell

I have seen and heard some of the funniest things during my visits to the Veterans Hospital. I’m just trying to share the laughs --- Send in a voice message: https://anchor.fm/kingk3lso/message

Dr. Colleen Jakey, Chief of Staff for the James A Haley VA hospital discusses where the hospital is in connection to returning serves or modifying services as the result of the Corona Virus pandemic. The good news is that hospital operations are returning albeit slowly to pre-Corona virus levels, with certain procedures instituted to ensure the patient's safety, their visitors, and the staff.Clinics will quickly return to what will be thought of as a new normal and Dr. Jakey explains what you can expect from the clinics as far as service is concerned. If you have another of the 170 VA Hospitals from which you are getting your care, listen to it to see what Haley's doing it will give you information with which to ask your questions of your facility. Episode 36

Updated Thursday at 7:33 a.m. CT A man armed with a shotgun was killed by VA police as he tried to enter a Milwaukee veterans hospital, according to Department of Veterans Affairs officials. The man was stopped by VA police outside an entrance to the Clement J. Zablocki Medical Center in Milwaukee at about 8:40 p.m. on Monday. Police ordered him to drop his gun, but he refused and threatened police, who fired multiple shots, authorities said. He was taken to the hospital's emergency department, where he died, officials said. No one else was injured. The Milwaukee County Medical Examiner's Office lists the person who died as a 35-year-old Black man. And, the Milwaukee Journal Sentinel and at least two television stations have reported the man's name as Joseph W. Denton. Details about why he was at the hospital haven't been released. The VA said the man was not a veteran. The VA has not disclosed the names or race of the officers who encountered Denton. The Milwaukee Police Department is

VetArtSpan host Fred Johnson interviews music therapist Natalie Quintana and art therapist Merrilee Jorn about the intricacies of their work with veterans in the hospital and the community setting.

In a park off of River Road, nearly hidden by scrubby grass is a mystery: an about 50-foot wide stone circle marking long-ago infrastructure. This ring intrigued Curious Louisville listener Jim Turner, and he asked about it. “I heard [the circle] was a wading pool administered by the Louisville Water Company in the late 1800's. Is that true?” he wrote. Turner grew up in Louisville, not far from the stone circle. He remembers riding his bike from Field Elementary to the waterworks on Zorn Avenue. “The waterworks was my playground because I grew up very close to it. I rode along and through the waterworks property going places I probably shouldn't sometimes. But when you're a kid, an indestructible kid, adventurous, that's what you do.” So when one day Turner saw an old picture, taken from the distance that appeared to show a body of water — he thought maybe a pool — at the site of the stone circle, it made him curious. Turns out, this stone ring in that's now in a fairly inauspicious place — the Champions Park dog run — was actually part of a lofty nineteenth century vision of a genteel Louisville lifestyle, made possible by pumped household water: “The grounds will furnish our citizens with a delightful place of public resort where the man of business can find recreation from toil and oblivion of care, women and children obtain unrestricted exercise and amusement in the open air and the infirm consult heaven’s pure atmosphere and the genial sunlight as their medical advisors.” That’s from around 1860, when the Louisville Water Company began pumping water. And it’s a description of the park around the stone circle. Louisville Water spokeswoman Kelley Dearing Smith said she believes it was written by Charles Hermony, the company’s chief engineer and superintendent. In 1860, the water company’s major infrastructure was all located near the intersection of Zorn Avenue and River Road. There was the water tower and pump station; those are still standing. There was the city’s original reservoir, which was on a bluff where the Veterans’ Hospital is located today. And across the street, at the current site of the Champions Park dog run, was Water Works Park. A central attraction of the park was this fountain. And in 1860, it was an engineering marvel. “So what they did is, they took the pressure that was coming off of the water in the reservoir — because it's on a bluff right behind us,” Dearing Smith said. “And that pressure helped the water to shoot up into the air from the fountain.” Unfortunately, Hermony’s vision was never really fully realized. Dearing Smith said the park was damaged shortly after it was built, by soldiers walking through on their way to fight in the Civil War. There were also possibly some other problems with upkeep, and with the park not being the attraction it was expected to be. By 1879, Louisville Water had built its current Crescent Hill reservoir, and the original reservoir wasn’t needed. That stone circle is what’s still visible of the fountain. If you go into the dog park today, it’s hard to miss: it’s the site where all the little plastic wading pools are gathered, to help small dogs cool off in the summer. And Jim Turner wasn’t the only person to wonder about it. We’ve gotten a few questions at Curious Louisville, and Dearing Smith has fielded some at Louisville Water, too. Sometime this spring, Louisville Water and Metro Parks plan to put a sign at the site, so everyone who comes to the Champions Park dog run will know the history of Water Works Park. Have a question of your own? Ask it at CuriousLouisville.org.

In a park off of River Road, nearly hidden by scrubby grass is a mystery: an about 50-foot wide stone circle marking long-ago infrastructure. This ring intrigued Curious Louisville listener Jim Turner, and he asked about it. “I heard [the circle] was a wading pool administered by the Louisville Water Company in the late 1800's. Is that true?” he wrote. Turner grew up in Louisville, not far from the stone circle. He remembers riding his bike from Field Elementary to the waterworks on Zorn Avenue. “The waterworks was my playground because I grew up very close to it. I rode along and through the waterworks property going places I probably shouldn't sometimes. But when you're a kid, an indestructible kid, adventurous, that's what you do.” So when one day Turner saw an old picture, taken from the distance that appeared to show a body of water — he thought maybe a pool — at the site of the stone circle, it made him curious. Turns out, this stone ring in that's now in a fairly inauspicious place — the Champions Park dog run — was actually part of a lofty nineteenth century vision of a genteel Louisville lifestyle, made possible by pumped household water: “The grounds will furnish our citizens with a delightful place of public resort where the man of business can find recreation from toil and oblivion of care, women and children obtain unrestricted exercise and amusement in the open air and the infirm consult heaven’s pure atmosphere and the genial sunlight as their medical advisors.” That’s from around 1860, when the Louisville Water Company began pumping water. And it’s a description of the park around the stone circle. Louisville Water spokeswoman Kelley Dearing Smith said she believes it was written by Charles Hermony, the company’s chief engineer and superintendent. In 1860, the water company’s major infrastructure was all located near the intersection of Zorn Avenue and River Road. There was the water tower and pump station; those are still standing. There was the city’s original reservoir, which was on a bluff where the Veterans’ Hospital is located today. And across the street, at the current site of the Champions Park dog run, was Water Works Park. A central attraction of the park was this fountain. And in 1860, it was an engineering marvel. “So what they did is, they took the pressure that was coming off of the water in the reservoir — because it's on a bluff right behind us,” Dearing Smith said. “And that pressure helped the water to shoot up into the air from the fountain.” Unfortunately, Hermony’s vision was never really fully realized. Dearing Smith said the park was damaged shortly after it was built, by soldiers walking through on their way to fight in the Civil War. There were also possibly some other problems with upkeep, and with the park not being the attraction it was expected to be. By 1879, Louisville Water had built its current Crescent Hill reservoir, and the original reservoir wasn’t needed. That stone circle is what’s still visible of the fountain. If you go into the dog park today, it’s hard to miss: it’s the site where all the little plastic wading pools are gathered, to help small dogs cool off in the summer. And Jim Turner wasn’t the only person to wonder about it. We’ve gotten a few questions at Curious Louisville, and Dearing Smith has fielded some at Louisville Water, too. Sometime this spring, Louisville Water and Metro Parks plan to put a sign at the site, so everyone who comes to the Champions Park dog run will know the history of Water Works Park. Have a question of your own? Ask it at CuriousLouisville.org.

The Radio Boys (C.Truth, Kev Lawrence) talked with the uber-talented performing arts star Margot B. Margot (@MargotBingham) kicked it about: her run in the Broadway revival of the musical "Rent", the Pittsburgh jazz scene, her album "Live at the Hazlett," preferring a live band over singing tracks, working with charities (Boys & Girls Club, Veterans Hospital, Blind & Deaf children school) at a young age, playing Phyllis Hyman in a future movie, choosing performing over sports, love of true crime movies, people watching in New York, winning Miss Black Teen, what it was like working with John Leguizamo, working on the web series "In Between Men" that was picked up by a network, having a pleasant young girl modeling experience, taking Forensic Psychology before musical theater and more. Margot is what you call a quadruple threat. For additional content go to: www.thermalsoundwaves.com Tweet: @thermalsoundwav IG: @thermalsoundwaves Facebook: @thermalsoundwaves --- Support this podcast: https://anchor.fm/thermal-soundwaves/support

The Army considers a new common ammo for the M4 replacement and the squad automatic weapon, and the new Veterans Hospital ratings are in.

Dr. Jacquelyn Paykel, Director of Whole Health System at the Veterans’ Hospital and Clinics in Tampa, Florida, and Director of the THRIVE Program, reveals her grit in bringing ancient philosophies of care to meet the whole needs of veteran patients.   Key Takeaways [5:11] Dr. Jacquelyn Paykel made herself over with introspection and self-compassion with four prongs: understanding herself and having self-compassion, understanding her veteran patients as part of the tribe, serving leaders by understanding their values, and understanding the VA’s organizational goals. [11:52] Jacquelyn’s training years were filled with the stress associated with terror. Stress can be productive depending on how you perceive it. Negative stress can cause damage. Positive stress can be healthy. If you exercise grit, you build confidence in yourself. [16:47] Early on, Jacquelyn collided with a medical practice’s traditional culture with her new ideas and agenda. This created tremendous stress and daily scrutiny due to the lack of trust. Her grit came into play when she was on notice every day for a year to perform under pressure. She learned that she wasn’t stuck. She could always change where she was and the way she behaved. It was a valuable lesson. [31:47] Dr. Jacquelyn Paykel is at the tip of the spear of changing minds and behaviors in a field that’s not known for changing quickly. Hold your uniqueness without displaying it. [36:51] Jacquelyn explains THRIVE, a multi-disciplinary 14-week program that brings veterans together in a standardized curriculum based on positive psychology, integrative medicine or understanding self, and acceptance and commitment therapy. In the 14 weeks, the veterans form a tribe and support each other. The teaching staff also learns how to teach again. [42:35] Leaders find value every day in their own work, model their passion for others, and then allow them to find what makes them tick to interact with the world in a valuable way.   Email: Jacquelyn.Paykel@VA.Gov Twitter: @DrPaykel_OBGYN Facebook: @Dr.JacquelynPaykel LinkedIn: Jacquelyn Paykel   Quotable Quotes   “It’s in belonging — feeling like we belong — that we really can live our best life.”   “Stress is a very significant aspect of my training years. … there’s a significant amount of stress even now … it’s a 24/7 job.”   “If you don’t have barriers up, people will naturally migrate towards you to help.”   You can change where you are and you can change the way you behave. And sometimes you have to change both.   Hippocrates emphasized the natural aspects of medical care and doctors are getting back to that.   “It really is about kind and compassionate care that will help these individuals heal. Each treatment has a placebo effect.”   “What I needed to do was acclimate and people needed to acclimate to me.”   When you move into a new situation, understand the environment and prove your worth to the people on the ground.   “When people have confidence in you then you can do those creative processes and move forward from there.”   “We as leaders generally find value in what we do every day ... but it’s our obligation to model that for other individuals.” Bio Dr. Jacquelyn Paykel is a gynecologist and integrative medicine physician who trained at the University of Wisconsin and completed a fellowship in Integrative Medicine at the Arizona Center for Integrative Medicine under the direction of Andrew Weil. She is a United States Navy Veteran. Dr. Paykel has practiced in private and academic settings since separating from the Navy but found her way back home with the Veterans Health Administration in 2014. Currently, she is the Director of Whole Health System at James A. Haley Veterans’ Hospital and Clinics in Tampa, Florida. She is also the Director of the THRIVE (Transforming Health and Resiliency through Integration of Values-based Experiences) Program, a novel health care approach that is based upon the tenets of Integrative Medicine, Positive Psychology, and Acceptance and Commitment Therapy.   Books mentioned in this episode Wired to Eat: Turn Off Cravings, Rewire Your Appetite for Weight Loss, and Determine the Foods That Work for You, by Robb Wolf  

Betty Meyer a “north-ender with a South End heart” lived in the South End for 20 years. She is 91 years old, a great grandma and a lively woman. Betty is an avid volunteer at Newark Hospital, Licking County Alcohol Prevention, as well as the Veterans Hospital. Betty has been dedicated to doing anything and everything to better her community (Bartoshuk, Blake, Cook, Gunn, Schratz and Stark, 2013). --- The South End of Newark, Ohio is an area that is literally and figuratively made up of side streets. The South End is comprised of three district areas that border the south side of the main square of town. It is home to a variety of people, churches, and community organizations that have deep emotional ties in the area. Several families have lived in the South End for generations. Newark itself is a town not unlike many towns that are struggling financially across the United States. It has a rich history, was once bustling with commerce and community involvement, and has been significantly impacted by outsourcing, downsizing and suburban sprawl. The South End has been directly impacted by the closing of schools, stores and industries such as the railroad and the Heisey Glass Company. Where once it was a thriving community and as one participant noted, “complete,” the South End now experiences: high unemployment, low levels of academic achievement beyond high school with dropout rates of around 27%, a population of around 44% renters, and an average income of 35,000.00 for a family of four (Gunn 2103). These podcasts were produced by students enrolled in Professor Anne Crowley's “Technology & Learning” course in collaboration with students in Dr. Amanda M. Gunn’s “Communication and Culture” senior seminar. Many thanks to the South Newark community members who shared their recollections, hopes and dreams: Skip Shoemaker, Norma Francis, Desiree Blake, Mattie Blake, Mattie Blake, Bryan Anderson, Barbara Ford, Earl Harris, Shirley & Wayne Campbell, Betty Meyer, Paula Hatfield, Judy Sayre, Dee Hall, Anne Reese, Judy Davis, Mary & Ginny Grady, Rodney Cook, Amanda Vozzella, Renee Chalfont, Glenn Hopkins, James Durant, Thelma McFarlane, Anna Lou Jones, Sharon Oliver, Deb Crane and the Hupp family. Bibliographies written by project coordinators (Bartoshuk, Blake, Cook, Gunn, Schratz and Stark, 2013).