Conversations to Cultivate Change - Episode 1

In this episode of Conversations to Cultivate Change, host Dr Keerti Gedela sits down with consultant ophthalmologist and Director of Research & Development, Dr Christiana Dinah, to explore her inspiring journey through medicine and research. From her early years in Nigeria to breaking barriers in UK healthcare, Christiana shares her experiences of being championed and underestimated, navigating career challenges as an immigrant, and using her unique perspective to drive inclusion and innovation in clinical research.

Join us for an engaging and thought-provoking discussion on resilience, purpose, and how we can better support diverse voices in healthcare.

Transcript

00:00:00:00 - 00:00:41:06

Keerti

Hello and welcome to the podcast of the National Institute for Health and Care Research, the NIHR. My name is Keerti Gedela. I'm your host, and I'm really excited to share conversations with different NHS and research staff to understand challenges around equality, diversity and inclusion. Evidence suggests sharing experiences can help us connect, understand each other, increase our sense of value and improve communication between people who may perceive themselves as different.

00:00:41:08 - 00:01:06:21

Keerti

It's a work in progress and every story matters. I'll be talking to NHS and research staff from different backgrounds and from different professions. We'll explore themes of workplace integrity, barriers to career progression, purpose in our work and guests discuss some of their personal journeys. We'll also explore themes related to building trust between the public and science, and what we need to do better.

00:01:06:23 - 00:01:40:17

Keerti

So I request one boundary. There may be listeners who disagree with responses and content or perceive a problem differently. That's of course understandable, but open discussion and hard conversations are important. We ask that any comment about this podcast if communicated with respect. So let's make a start and get ready for some conversations to cultivate change. Welcome, Christiana. It's been a long time coming recording this conversation with you, and I know it's going to be a good one.

00:01:40:19 - 00:02:04:02

Keerti

Miss Christiana Dinah, you’re a consultant ophthalmologist and director of research and development at the London North West Healthcare Trust. You've pioneered clinical trials and research in your region and led fantastic work related to inclusion and clinical research as R&D director. And I hope we get to cover some of that work today. But I was hoping to get to know you a bit more.

00:02:04:04 - 00:02:26:02

Keerti

It's very clear to me that you are led by passion and purpose, and a drive for ambitious health initiatives. The other thing that's very clear from interacting with you is you have this immense positive energy. And Christiana, it is contagious. And the thing I feel from you is that you use this energy to support others. You're a champion for people.

00:02:26:04 - 00:02:48:05

Keerti

So I'm delighted to work with you. I'm delighted you work for the NHS. But to start, I wondered if you were happy to share something of your background and early career journey. I tend to think people that are natural champions for others must have had people who champion them. But I'd love to have your lens on that.

00:02:48:07 - 00:03:21:15

Christiana

Thanks so much, Keerti, for the very kind and articulate introduction. I would say I think I agree with you about that. I would describe myself as being certainly in my, in my young years, extremely well supported. So I'm Nigerian born and bred. Grew up born in Lagos. I'm Yoruba. So Nigeria has multiple tribes. And I'm from the Yoruba tribe, which is in the south.

00:03:21:17 - 00:03:54:10

Christiana

And both my parents are Yoruba. And one of the things about Yoruba people is that we value resilience a lot, value grit. But interestingly, there is a bit of a, I guess, sexism thing there where growing up, well, not in my time, but before my time, male children were more valued than female children. So my mum had four daughters.

00:03:54:12 - 00:04:16:16

Christiana

In that context, that I think she was going to keep going until she thought actually four is probably enough. At this point, this is my lot. But what my parents did do is say, look, we haven't we haven't got. My my mum specifically, you know, she's only got daughters, but she wants, she's going to treat them like sons, which I think is very much how we all are today.

00:04:16:16 - 00:04:37:05

Christiana

Which is boy or girl, whatever. Your horizons are limitless. But I think growing up in Nigeria and Lagos at the time was probably fairly, different. So she, you know, I was championed from a from as little, you know, from like 3 or 4. I remember my parents always drumming into, into us that you can do anything.

00:04:37:05 - 00:05:07:00

Christiana

You can be anything. And I think my earliest recollection of thinking about science as a career was probably 7 or 8. I read, it was in the 80s and there was the whole HIV, sort of crisis or pandemic and there was quite a few newspaper articles in Nigeria back then around some of the scientific, efforts to try to, you know, cure AIDS or find a cure for it.

00:05:07:02 - 00:05:24:16

Christiana

And, you know, it got my whole family was interested, like, my parents would be talking about this over the dinner table. I thought that might be something one day I grow up, you know, to be, to do. But, of course, like anything else, I got sidetracked. I think when I was about ten, I decided I was going to be the next Michael Jackson.

00:05:24:18 - 00:05:50:14

Christiana

And spent a lot of time in front of the mirror, you know, trying to do all the dances. And it took me, it was heartbreaking when I realised I actually couldn't sing. It took me years to to, you know, just accept that that's not the gift that I had been given and then went back to obviously considering science, but but certainly, growing up I was championed and along my career I have been championed.

00:05:50:16 - 00:06:13:09

Christiana

So I moved to the UK aged 16, went to a boarding school, and at that time, I knew I wanted to be a doctor, as I said, and my dad and I would, he would fly in every three months or so and we would strategise, you know, how we're going to get into med school, because at the time, there was a really small quota of foreign students that could go to medical school.

00:06:13:11 - 00:06:35:08

Christiana

So we knew it was going to be competitive and we would have this strategy of, you know, top schools, med schools, you know, maybe average or whatever, just trying to get into medical school. And I remember getting no offers and just feeling really devastated. And another point of support is my biology teacher saying it's not the end. You can still get some clearing.

00:06:35:10 - 00:06:59:20

Christiana

Chin up, you're good enough. You know, that sort of stuff. For foreign student, that meant so much because I was away from home. My parents were in Nigeria. I'm an African student in a school that had maybe 5 or 6 of us, was mainly to be fair, was an international school. So actually we had people from all over the world, which was comforting, because you didn't feel too different.

00:06:59:20 - 00:07:17:11

Christiana

But, you know, we were different. So, so that was one big thing. My biology teacher. And then once I got into med school, through clearing, after my dad and I actually went from university to university in London, you know, my dad's sort of knocking on the door. Can I speak to registrar? My daughter, she's the best. You really have to take her in.

00:07:17:16 - 00:07:44:20

Christiana

So again, awareness of someone really thinking a lot of me, has been my experience really all my life. Once I did get into medical school, I have some key times that stick out as feeling really supported in the midst of being, again, an international immigrant in medical school in London, at Georges. There were points that I really did feel very supported.

00:07:44:22 - 00:08:05:24

Christiana

I did an intercalated BSc, which is amazing, helped me crystallise what I wanted to do research wise. I knew I wanted to do research, but I remember then also realising I didn't want to always be in the lab. So I would ask my supervisor, and he gave me a couple of pictures of the people affected by the condition I was working on so I could feel that connection.

00:08:06:03 - 00:08:31:11

Christiana

So I knew I wanted to be a physician. That helped crystallise. I want to be a clinician scientist. I want to be some sort of researcher. But really clinic based on the coalface of it in the NHS. So yeah, I champion people because I've been championed and I've seen what those, what that encouragement, what it feels like to have people speak up for you when you're not in the room.

00:08:31:13 - 00:08:56:20

Christiana

I think a great example as well is when I was applying for my very first F2 role, which had ophthalmology, was very competitive, and I think it was 600 people for six jobs or something. And I'm, I'm thinking one they’re going to interview a lot of people but two they'll have to sponsor my visa. So, you know, to take me over others would be, would be a big jump for them.

00:08:56:22 - 00:09:18:14

Christiana

Then in interviewing for that role, when I got to the, to the final step, they said, would you take the ophthalmology one or would you be happy if we offered you the ENT one? And I knew I wanted to do ophthalmology, so it was. But at the back of my mind I'm thinking if I say only ophthalmology, knowing how competitive it is, and I don't get that, I'm probably going to have to go back to Nigeria because I have my visa.

00:09:18:16 - 00:09:42:03

Christiana

Depends on extension, depends on this job. But then I, I kind of thought, you know, you have to, you know, you're either playing or you're not, you know, you have to really just go with your gut. And I remember sort of my voice shaking and the interviewer said, just say the one you want. So I said, yeah, ophthalmology.

00:09:42:03 - 00:10:01:08

Christiana

I got the job, which is great. Went back to my FY1 role, which was with Graham Thompson, an opthamologist at George's, and he said, of course you got it. One, you're good enough. And two, I wrote the strongest reference for you. If they hadn't given it to you, I would have had a problem with it.

00:10:01:08 - 00:10:20:02

Christiana

And I thought again, support. I didn't know he wrote a great reference for me. So sometimes, you know, obviously as an immigrant, there's, it's not all rosy, but I have had people champion me along the way at key points that I think has opened the door for the next step.

00:10:20:04 - 00:11:04:21

Keerti

And Cristiana you see, you see why that’s so interesting and powerful is that that's not necessarily the story for other people that are similar to you in this country, arguably, or certainly maybe not their perspective. It’s interesting because I think there is there is data, isn't there? When you look at at the Royal College of Physicians, for example, and you think about the proportion of complaints that come through on physicians and surgeons and, not only that, I guess that the, the, the way in which the system might look at and manage physicians and surgeons of colour, there seems to be this disparity.

00:11:04:23 - 00:11:31:07

Christiana

I think there is a there's 100% a disparity. And that's been my experience too. So, like I say, I have had this key experiences that I think have been instrumental almost, almost sort of, you know, you're almost thinking, should I give up? And then boom, something happens, some support comes that you don't envisage or even plan for. And you're like, yeah, you know, I could keep doing this.

00:11:31:09 - 00:11:58:13

Christiana

So I've had those experiences like Graham Thompson supporting me for that role was really key. But then I've also had, I'm always, I think, underestimated. I don't have the, the level of support of consistent support that I think someone who is not an immigrant, that is maybe British, that has even maybe half my ambition would have.

00:11:58:15 - 00:12:24:03

Christiana

But I, I've been accused many, many, many times of always looking at the upside. I genuinely don't look at those things because I think for me, it would just drain my energy. I think my energy really comes from focusing, firstly, having a very supportive family, but also looking at the few times and they're few. I can count them on two hands where I've really felt championed.

00:12:24:03 - 00:12:52:14

Christiana

But those times I've been critical, right? They have been needle moving for me now, you could argue, and you would be right to say that if I was British born, you know, different skin colour. I could be, I don't know. In Chris Whitty’s post at the moment, possibly, right, possibly, but these are the hands, right.

00:12:52:14 - 00:13:18:05

Christiana

And, you know, that we’re dealt. And for me, I don't see, I actually think my the fact that I'm an immigrant, the fact that, I'm from specifically from Africa, Nigeria, all of these experiences mean that I bring to the table what someone else can't possibly bring to the table because they haven't got my perspective, they haven't got my experiences, and they simply don't even look at the data the way I do.

00:13:18:07 - 00:13:38:14

Christiana

So they wouldn't, you know, they they would look at the same piece of work and not see the things I see. So for me it is essentially my superpower. Right? And I've embraced that and I and I champion it and I love it. My goal now is to give that very freely, indiscriminately to as many as I can.

00:13:38:16 - 00:14:00:06

Christiana

And I would like to hope that, you know, we all do. We all sort of overlook people and stuff. But I try not to because I genuinely think, and more than not overlooking people, I really spend time trying to understand you know, what someone's strengths are so I can point them in the right direction. I can tell you an example of some of the stuff I'm talking about.

00:14:00:09 - 00:14:24:11

Christiana

When I was in FY1, talking about going, before I even went for the interview I mentioned to you in my general surgery job, I had said I want to be an ophthalmologist. My general surgical consultant said that I should consider optometry because the chances of me becoming an ophthalmologist is zero to none, and if I'm really into eyes, I can become an optician right?

00:14:24:13 - 00:14:45:12

Christiana

And he didn't blink. It wasn't. He didn't feel uncomfortable saying that. He was very clear. I really don't think this is for you. You can't do this right. In A-level college, when I said I want to be a doctor, they said impossible, go be a teacher. And they actually went as far as writing that in my references, which is why I didn't get any offers to start off with. My references

00:14:45:12 - 00:15:08:19

Christiana

all said better as this, better is that blah blah blah. So there is always people underestimating you, you know, counting you out, always thinking that you're not capable of what you're capable of. But here's the thing. Now that I've got little kids, what I try not to do is come from that perspective. So find myself constantly saying, oh, I have to prove this.

00:15:08:19 - 00:15:25:00

Christiana

No, I have to prove nothing to no one. You know, I think it helps that I grew up in Africa from 0 to 16. I didn't even know I was black, I was just a person. Because in Africa we're all Africans, right? So I'm not walking around with this oh, they have it out for me because they probably do.

00:15:25:02 - 00:15:51:12

Christiana

But I can't let your, because when I look at things from that perspective, I'm always trying to prove to you that I am something. And I think that just beats us up as people. And we end up almost always over working, trying to prove something. So when I was saying to my son, I've got a eight year old son, I want you to have the the freedom to be mediocre if you want to be.

00:15:51:14 - 00:16:11:04

Christiana

Now, that's shocking for an African to say, because the whole point has been, my father would just, you know, shake me. What do you mean? You know, excellence is who we are. It's in our blood. Yes, it is, but it's got to be because you want to do it. I'm driven because I genuinely want better healthcare for everyone.

00:16:11:04 - 00:16:38:20

Christiana

And I looked at the HIV story. It wasn't about who was affected or whatever. It was as if as humanity were affected by this virus. We want to tackle it wherever that issue or problem might be. So from that perspective, that's I always want to come from that energy, like we've got this disease or this concern as a society, and we can fix it as opposed to, we, I have to do this to show them, whoever they are, that I can do it.

00:16:38:22 - 00:17:00:19

Christiana

I don't ever want to come from that. And I don't ever want other people from Africa or that, from my ethnicity or other ethnicities to feel like I have to do what Chris is doing to prove that I'm something. No. You are it already. You know, you are it. You are gold. You know, you just need to be you.

00:17:00:19 - 00:17:20:11

Christiana

And just do you the best you can. We're all trying to figure it out, right? And I’m trying to figure it out every day. I'm juggling rebalancing, whatever it is. But every day I'm saying to myself, do not do it to prove anybody, to prove anything to anyone. This is who you are. You are internally driven. You want to make a difference.

00:17:20:13 - 00:17:47:01

Christiana

And yes, there are hindrances and obstacles, and people who will underestimate you, I found been on this meeting, actually, exciting now because I'm like, they have no idea. And actually, because they underestimate, they're not even going to try to stop me. They won't even see it coming, you know what I mean? So so from my perspective, these do just think I can't write as long as whatever it is I'm trying to do is a goal.

00:17:47:01 - 00:18:06:14

Christiana

I have determined not one that I've chosen because I'm trying to prove something to you. Because I think we all have. I mean, say we've got 85 years here. Imagine spending that time trying to prove you wrong. And then I've got other things that really I was put on earth to do that I've not attended to because my entire energy is built around.

00:18:06:20 - 00:18:26:12

Christiana

And that's what I hate about racism, because you I feel like you end up shifting people's destinies, one by limiting them, but also by making them feel the need to prove something and completely neglect. Why are they here? By design?

00:18:26:14 - 00:18:57:03

Keerti

Yeah, yeah. Oh, gosh. Christiane, there is so much and I. Yeah, you've inspired I, I hundred and 10% agree with everything and I, I think what you've been talking about, there's a lot to deconstruct, isn't there, because, you know, listening to you, it's very clear you have this foundation of self-healing, this belief, you know, self that came young.

00:18:57:05 - 00:19:16:12

Keerti

What is very interesting to me, not just as a human being, but as a mother, as a doctor and researcher, become a real advocate now and a budding social scientist, because I think actually, if I'm going to think about this space and apply it, I need a, you know, as a, as a doctor and a scientist, if I'm going to do it in my profession, I need a space for it.

00:19:16:12 - 00:19:40:08

Keerti

Right? And that's it for me, social science, it's all these factors and you have this foundation of grit, of integrity, of self value. And so someone like yourself is not going to other people who underestimate you and value you less. You're not going to be controlled by them. That in many ways is is part of this superpower, isn't it?

00:19:40:08 - 00:20:06:13

Keerti

And actually, that's it, that trajectory. And I completely agree with you about the point that it needs to come young because that trajectory, if it's established young, you fly, don't you? If it's the stuff later on and you have to kind of suffer with the consequences of society and the consequences of how they value you, that's set in young, then actually your trajectory is is going to reflect that.

00:20:06:13 - 00:20:29:13

Keerti

And, you know, it'll take work to deconstruct it. That's when that's when your real Trump comes in. And and it's interesting when you're talking about underestimating it. And one of the things I think is really interesting is when people underestimate you, whether where's that coming from. And sometimes I think it just does come from they haven't really listened enough or they haven't experienced enough, but sometimes that can come from insecurity or underestimating people.

00:20:29:13 - 00:20:41:19

Keerti

And that's the that's how they are. And actually I often think is, look, what is it about your own insecurity that you should figure? Because if you figure that out, ultimately you'll be more content person.

00:20:41:21 - 00:21:04:00

Christiana

I have people I look up to, but I wouldn't say I have a mentor or that I have been mentored systematically. Because I guess I was an outsider. So, you know, so on the one hand, that's great because you can say, well, I've managed to achieve some things. And I'm really proud of the things I've done.

00:21:04:02 - 00:21:11:05

Christiana

But then again, you could say, well, could I have done if better supported and better mentored and so on.

00:21:11:07 - 00:21:47:07

Keerti

I've, I've thought about this a lot and we, we definitely had this space, didn't we, Christiana, where there's this thought process that if we were, you know, of a not minoritised group, let's say we were white men living in the United Kingdom, that we would have become more successful. And there's something I just want to counteract in that, because clearly, for so many individuals post migration, you know, at a time, at the end of colonialism and, where there was mass migration and we, we have data about inequality and, and people who suffer from inequality more than others.

00:21:47:07 - 00:22:13:13

Keerti

But, but one of the things that I would say and argue is this issue of grit and, and the migrant mindset, and actually, I think, for example, for myself, that I don't think I would have been any different if I was a white woman and in many ways, would I have lacked the grit if I didn't have the parenting, mindset that I had?

00:22:13:13 - 00:22:31:24

Keerti

You know, there were pros and cons to my parenting, but there is a mindset that I think is similar and different to yours related to work ethic, grit, and integrity and self value. The thing I value most of all, in the way my father's approach was, was exactly. He was a very strong advocate for us. It didn't matter.

00:22:32:01 - 00:22:53:22

Keerti

Very strong advocate. A very child centric father and that, you don't lose it, you know, and actually, I think what then suffer racism. So if I was to look back on my childhood, I saw them suffer racism more than perhaps I than I experienced myself. But I also saw him shout back, you know, shout back and be rude.

00:22:53:22 - 00:23:11:17

Keerti

And actually although at the time I would have been super embarrassed when I reflect on it. It meant that he valued himself. Right. And I think, I think that is something that is precious and it's something that the migrants have. And I think one of the challenges about when you do with my children is, I hear you.

00:23:11:17 - 00:23:33:21

Keerti

And actually, I would I would say maybe I'm wrong, but I also see you're competitive and you're ambitious, and that's brilliant. And that's right. Yeah. What I often think about with my children and I might reflect on am I those things are that you don't need to be competitive or ambitious as long as you value yourself. If you are competitive, ambitious, great, go for it.

00:23:33:21 - 00:23:40:19

Keerti

If you're not, but you value yourself, then you're going to fly because you're going to fly because you know what you're going to offer. And that's sort of.

00:23:40:20 - 00:24:17:21

Christiana

100% I first, I agree with all of that. I do think that if I it's interesting, it's always, you know, you can't really know what you would be like if you were different. What I, what I think is that if my self, my inner self, regardless of my outer casing. Right. So outer casing, Nigerian brown skin, you know, outer casing, maybe British white skin if the inner person is the same in terms of, my outlook on like my perspective, would I still have the same level of grit and resilience if I grew up here?

00:24:17:23 - 00:24:44:10

Christiana

I don't know, but what I do, what I know is that when you are transported from a place, wherever that may be, right, and you move to somewhere else, you've got a different accent and you have different, views, perspective, and you don't share the same, you know, thing references like, like growing up, I think for us it was like some Sesame Street here.

00:24:44:10 - 00:25:02:19

Christiana

I think people talk about Blue Peter, you know, I've heard this over the years, so I know these things, but I genuinely don't actually know what the jokes and Blue Peter are, you know? So it’s those are the things. So I don't have the same references. But I grew up, like I said, not just in Africa, actually. For few years we lived in France as well.

00:25:02:19 - 00:25:31:11

Christiana

So I'm pretty much the child of an expat. And what that also means is you learn adaptability pretty quickly as well and you celebrate difference. Because I was going from international school to international school to international school. So to me, the world is big. And I suppose it shocked me when I met people and their world is really small, you know, like I trained in Newcastle, and Sunderland and Middlesbrough and some people there.

00:25:31:11 - 00:26:02:24

Christiana

Their world is really small, but I'm not even I don't see it as necessarily, I, I suppose I see those things more as a lack of exposure and maybe not necessarily racism, because I think racism is to do with and I'm not a race expert, but my understanding of racism is to consider somebody as inferior based on skin colour as opposed to different.

00:26:03:01 - 00:26:25:22

Christiana

And obviously, as I said, growing up as an expat moving around and stuff, I saw differences, but I saw them as things to celebrate and to be excited about. And I wanted to make friends from all these different cultures. And it's interesting that not everyone sees it that way. So I suppose my experiences mean that I look at the world in a certain way, while, probably actually feeds into my grit and my resilience.

00:26:26:01 - 00:26:44:17

Christiana

Because when you move as a child, certainly you have to find some sort of inner strength whereby you show up in that classroom and there's only you looking like you, and you're hoping that. And I think every child has this when they move schools, even if there's no colour difference or foreign difference, you know, it's new people, are we going to get on.

00:26:44:17 - 00:27:02:22

Christiana

Am I going to make friends? But yours has the overlay of will they understand me? My my accent is different. Would I, when they say joke, would I understand it because I'm from somewhere else? You know, all those things probably helped to build that resilience of friends or not. I'm going to have to be okay because I have no option.

00:27:02:22 - 00:27:35:14

Christiana

I'm not. I'm not going anywhere else. This is my new school and this is my new position. And I have to somehow figure it out. And you translate that experience into maybe now med school, medicine. You know, growth of career, whatever. Knowing that. Fine. You know, I may not already have friends on this board, but I I've learned over the years, over the decades to build bridges and build alliances where maybe that was none before.

00:27:35:16 - 00:28:00:09

Christiana

And I've had to learn that because of the way I've grown up. So, yes, I think a lot of that comes from being a migrant. I don't think I could have had any of that if I wasn't a migrant and from Africa and all of that stuff, which is why I say it's a superpower, right? It genuinely is a, a special thing that, that we have.

00:28:00:12 - 00:28:06:11

Christiana

But obviously may also attract negative experiences.

00:28:06:13 - 00:28:29:07

Keerti

Yeah. When I was just thinking that maybe we won't go down this route, but in, in some of the narrative we see in this country, but also around the world is, how that can be a threat. So when you when we talk about racism, actually, how much is racism related to in understanding somewhere in your conscious that's a threat?

00:28:29:08 - 00:29:03:01

Keerti

You know, somewhere that sits in, in humanity, doesn't it? And where people that want to connect. And I think we made that connection with other people. But it sits in that place of I guess it's all societal, isn't it? If you're brought up with that mindset and then you see that maybe a group of people that seem different to you or than a threat where you need to gain control, you know, but, we talked about this when we had coffee, but I saw a short interview with, a Nigerian author, Chimamanda Ngozi.

00:29:03:03 - 00:29:04:00

Christiana

Oh, yeah.

00:29:04:02 - 00:29:29:14

Keerti

Yeah. And she's not short interview. She was saying something really quite similar, and she's Nigerian, and she was saying that when she grew up in Nigeria, you don't see yourself as a black. Of course, everyone's black. You don't see yourself as black. And then when she came to the United States, everyone treated her with the perspective that she is black.

00:29:29:16 - 00:29:31:03

Keerti

Yeah.

00:29:31:05 - 00:29:35:17

Christiana

Which was strange and weird experience, it really is.

00:29:35:19 - 00:29:56:16

Keerti

But in many ways, I think what I heard from that short interview was she was saying, but for the majority of her upbringing, though, she didn't identify as black in the way that she was perceived to the United States and the way that you're perceived in the United States as being black is not a value free idea. It's the whole point that you're being perceived with assumptions.

00:29:56:18 - 00:29:57:11

Christiana

Yes.

00:29:57:13 - 00:30:21:07

Keerti

I think what we were talking about before was also this issue that if you, are brought up for a lot of your childhood not seeing that, then how protective is that? Because for people, for young black people or young people of colour growing up in the United States, in the UK, in the global North, are they being conditioned differently?

00:30:21:09 - 00:30:31:21

Keerti

You know that actually you you from the day you were born, you're perceived as black. It's not, you know, and therefore you take on those assumptions. From from when you're born.

00:30:31:23 - 00:30:59:04

Christiana

Yes I think I think you're right. And I worry about this with my kids because, you know, I'm raising them here. They're born here. So in their minds, I actually remember my kid at three asking me, then why there's so few black people in his in the world, actually, in, in, in his entire world. And I said, well, no, no, no, there's more black people in the world.

00:30:59:04 - 00:31:37:12

Christiana

And he argued with me. He was three. And I was like, you know, you have to at the time, he hadn't been to Nigeria. I was like, you have to, you know, there's the whole of Africa, a lot of South America, blah, blah, blah. You know, the reality is, whatever we say currently growing up, and it's interesting because I do think your childhood years or not, that I think there's evidence to suggest that, you know, your for formative years are really critical and that sense of self that you form at that stage is embedded really.

00:31:37:14 - 00:31:58:01

Christiana

I'm not seeing myself as a minority. I even now I don't see myself as a minority. I just can't because I just didn't grow up a minority and I'm aware that I'm not a minority like in the, you know, the universe. Right. But trying to tell my kids that it's like, it's like trying to tell them a science fact, but, you know, there is gravity.

00:31:58:03 - 00:32:25:00

Christiana

Believe me, there is gravity. And if you went to space, it's it's so alien to them because they genuinely see themselves as a minority in the UK. And yes, we travel, but we tend to go to Nigeria once a year, we probably need to go more. Because I do think that sense of Africanness is it's it's who they are as well as being British because they are born here and they've grown up, you know, all of that.

00:32:25:02 - 00:32:48:01

Christiana

So for me, it's it's it is it is important. And I think like, for instance, to go back to research it, it clearly influences what I see. So I grew I trained in Newcastle, like I said, so very homogeneous whites. And I mean this is a place where sometimes I actually remember a patient once, said, can her son touch my skin because he's never seen a brown person, literally.

00:32:48:03 - 00:33:10:22

Christiana

So, you know, I don't see that as racist. I see that as just lacking in exposure. Like, where have you been? You know, but okay. And then I start working in Central Middlesex, which is one of the most diverse places in the UK. And all my patients are brown and black and, you know, Middle Eastern and all sorts.

00:33:10:24 - 00:33:35:11

Christiana

And I started to notice, particularly in my diabetic patients, that the diabetic presentations look different. I noticed that literally within the first like six months of working there. And I remember talking to my trainees about it and then the Trust had this, research award that they do once a year. And at that time, I just set up the clinical trials unit.

00:33:35:13 - 00:33:53:22

Christiana

And what I always do, and this is for like, I guess anyone really growing their career is even when I don't think, you know, whether I’m talking about award or whatever, you know, even if I don't think I qualify, I always apply. It's just it's it's like what will happen is I'll get the experience of applying, they'll know that she's ambitious.

00:33:53:22 - 00:34:35:14

Christiana

She probably doesn't know what she's doing, but she’s ambitious. And one day it will be my turn. I would always try right. So I present this this piece at the Trust Award. This is in 2018. And in attendance was the CEO of NIHR at the time. And I won best research in the whole Trust. And what was crazy is I saw it as an interesting thing to to to note that we have this scenario where a lot of our patients have kind of West vision, but the, the, the leaking is not as much as I'm used to seeing, you know, so the correlation between what they're seeing and the thickness was didn't seem similar to

00:34:35:14 - 00:34:58:19

Christiana

what I was experiencing, what I had seen up north and a very simple idea right. In addition to the fact that we had managed to recruit the most, into like over 200% or whatever into a trial because we made a fuss about the, the thickness and stuff, and that maybe the way I framed it as well, you know, basically we won the award and it got me thinking, this is interesting.

00:34:58:19 - 00:35:22:20

Christiana

Then the, the, medical director at the time tells me that the CEO of the NIHR found it so interesting that he said he would highlight it to the national lead, that there's someone in, there's an ophthalmologist in central London doing something quite interesting. I thought, this is interesting. Like, so this is actually a thing like, I, I thought it was an interesting finding, but I didn't realise.

00:35:22:20 - 00:35:45:15

Christiana

I didn't realise the weight of it. Let me say. But that made me think, well, if he's interested and he's telling this person, then there's something here. I better look at this properly. And then I dug into the literature and realised that a couple of people had published that year on the differences in thickness by ethnicity, or in the, in the retina.

00:35:45:17 - 00:36:03:03

Christiana

And then I looked at the NICE guidelines and I realised, of course, we have this threshold and actually very slight differences probably in quality and access to treatment. And these are the best treatments. And that's where that, so I started telling people and a lot of people I told had never I mean, I was the first person to mention this.

00:36:03:09 - 00:36:28:06

Christiana

No one had looked at and correlated that this could be a thing. And then we published a little commentary and I then I got invited to do the NICE guidelines and hopefully when that’s published we'll see a difference. But the point is those papers, some of that was already there before I noticed it. It just hadn't been seen that way because the lens was different.

00:36:28:08 - 00:36:55:18

Christiana

So again, when I say there's a superpower here, in addition to the fact that I guess for a lot of people, when they think about racism, they think about, also an inferiority of intelligence, which is just crazy to me because if you look at, you know, the top companies, you know, in tech, for instance, a lot of the CEOs are from the subcontinent of Asia, right.

00:36:55:20 - 00:37:20:05

Christiana

I like Google and so on, you know, so clearly this isn't genetically determined. It is more to do with opportunity. Right? And when you have the opportunity so that like I said, I mean, I did that, I was championed by my medical director, the NIHR CEO, you know, highlighted it. I applied for the specialty lead in the region.

00:37:20:05 - 00:37:38:02

Christiana

I got that post, you know, so, so things like that. So I have I can't say I have not been championed. I have been championed when I've taken the opportunity to say, look, I want to speak about this. Oftentimes I will say, I feel now that I'm given almost a megaphone to say what I want to say, and it lands.

00:37:38:04 - 00:38:00:11

Christiana

So there are there are opportunities along the way, but it doesn't mean that there haven't been challenges. But what I will say is that having someone like me, not just me, many of us like you, Keerti, that the views you bring are so unique and those perspectives are important. And having that diversity on the table is important and something we need to treasure and value.

00:38:02:02 - 00:38:21:20

Keerti

Christiana, the reason why it's so important. Well, actually it's the reason for this podcast. The reason why it's so important to hear you is that unfortunately, we know that there are, people who are minoritised and they don't feel like their trajectory can be the same.

00:38:21:22 - 00:38:24:04

Christiana

Yes. Which is right.

00:38:24:06 - 00:38:34:23

Keerti

Yeah. It's really important that they're hearing the lives and hearing the positivity of lives of people that they may identify with as being similar.

00:38:35:00 - 00:39:02:02

Christiana

Yeah. No, it's interesting. If there's a Prime Minister vacancy I’ll apply like literally I just do whatever. But, when the RNI role came up in my Trust, the director role, I did skip a beat there because I thought, I actually think I was right, that it's so administrative that it will take away from the time to develop my own grant and my own, you know, knowledge creating ideas and stuff.

00:39:02:04 - 00:39:25:07

Christiana

And to some extent it has. But I spoke to someone else who's a research and this is the piece around having. People you who are a safe space that you can discuss these things with. I spoke to one of the RNI, the RNI director in Sunderland who I did, she was a consultant when I was in those sectors.

00:39:25:08 - 00:39:44:15

Christiana

I kind of worked in her clinic for a bit, and I regard her as a mentor, and she sort of said to me, Chris, well, you know, you've got a daughter, you know, would you like when you think about this, think about it from that perspective. If it's something that is interesting to you and you want to, you think it will help you make a change.

00:39:44:15 - 00:40:06:18

Christiana

Because I did think I would be able to restructure things and make a change in the in the Trust. And your daughter grows up and feels is able to look up to you and say, look, you were still able to be a present mum and so on, and lead a large organisation in this way. And I thought, okay, when you frame it like that, absolutely.

00:40:06:20 - 00:40:28:18

Christiana

So it's never about do it so that they know you can do it or do it to prove someone else wrong. I'm always looking for one my own inner driver. Does this fit into the picture of why I think I've been placed on Earth? And does it fit into the picture of the problems I think I'm here to solve?

00:40:28:20 - 00:40:50:11

Christiana

And overarching does it now because I've got kids. Does it fit into the picture I'm trying to paint for them in terms of their role as citizens, wherever they find themselves. And it ticks all those boxes. So I thought, well, yeah, overall, I think I'm going to do more good by doing this than not doing it.

00:40:50:13 - 00:41:18:10

Keerti

Yeah, well, I'm glad you mentioned the work on on diabetic maculopathy. I have to say that was groundbreaking as well in a way that actually it's interesting, isn't it? I wish it wasn't ground-breaking. You read that and go it shouldn’t really be something that we're looking at now going, oh, it's really interesting. It's changing process within clinical trials, Christiana, so part of me was a little bit like, oh, I see we're here now.

00:41:18:12 - 00:41:43:05

Keerti

Christiana is translating this and I think this is this is the thing, isn't it? When you were talking about your lens and what you have to put on the table, you're absolutely right. But I think I'm sure you have it as well. There's a frustration, isn't there, because one of the biggest challenges that I've had being a researcher is you might understand something, but how is that being translated in the real world to process you making change

00:41:43:05 - 00:41:57:11

Keerti

That means it's meaningful and understanding something that's been based in data that takes a long time to get translated, when it just takes a few people who care. I think that's the other missing bit. It's not just your lens, it's about the care.

00:41:57:13 - 00:41:59:06

Christiana

Yeah, yeah.

00:41:59:06 - 00:42:23:00

Keerti

People care and then need to listen to a different perspective. And we need to listen to that, absolutely. But there is also a challenge you know, there are systems at play here and work goes on and we’re not caring enough to move it forward. And and I fundamentally believe I think like you. And again, another reason for this podcast is that we want to connect people to work with purpose.

00:42:23:02 - 00:42:43:10

Keerti

You know, and I think there's so much now and in data in psychology, data that suggests, you know, we are happier all of us doesn’t matter about our race, privilege. You know, we are happier if we work with purpose. You know, you can be from a more deprived situa, you know, situation in a lower middle income country. Your entire

00:42:43:13 - 00:43:04:00

Keerti

trajectory is different. An individual who might work on the land and who feels they have purpose. Their life trajectory may be different, but perhaps they still feel some level of, you know, why they would put on this world. And that translates to how they bring up their children. And I think, listen, yeah, you're you're an inspiration, Christiana.

00:43:04:00 - 00:43:16:15

Keerti

And I think it's it's important people hear from you. I think they are I think they are even in your every day because we hear it every day. But it's it's good to get a bigger context to it.

00:43:16:17 - 00:43:43:15

Christiana

And yeah, you know, I'm happy to, to, to share what I've done. I think that if I sit here and think about all the reasons why it won't work, I will never do it. So half the time I just don't I will look at why we can, how we can. So one of the things and sometimes that thinking helps you as well decide what not to apply for.

00:43:43:17 - 00:44:05:13

Christiana

So for instance, with the EDI role, I have to say the greatest thing I did. And one of the things I'm really happy about is working with you on your group, because I think if I’d applied for it, I might have gotten it because I, I'm on the exec and da da da, but I don't think I bring the lens that you bring to it.

00:44:05:15 - 00:44:33:07

Christiana

And I think your, the exposure that you've got with the work you're doing in, I want to say Indonesia. Right. Yeah. Yeah. Exactly. Indonesia. And okay. You know, to me like I learn so much from being, and I quote some of the stuff you say, no plagiarism directly, you know, in, in other circles, you know, because I'm just like, you know, she really knows what she's doing and she's super focused on this and wants to do it properly.

00:44:33:09 - 00:44:55:15

Christiana

So sometimes having that, being able to look at this, I'm just saying this because sometimes I think I can list all the things I am, you know, specialty colleague, exec this, blah blah blah, all these things, but they're all at least I would like to say, curated things that I think I can do and I can deliver on with the limited amount of time I've got.

00:44:55:17 - 00:45:27:19

Christiana

But what they do allow me to do is work with people like you and others in other avenues and boards. That means that I'm so much richer for that. And I think sometimes what what I don't want to happen, because I've seen this sometimes, is people just take on too much because, again, this idea of trying to prove they can do it, but then you don't really do things well or you're not well-supported and it ends up looking like you're incompetent when actually you just didn't have the right infrastructure, overcommitted or whatever.

00:45:27:24 - 00:45:57:04

Christiana

So I do think that, it's been a ride for sure. And I feel probably more as well as you that we're just starting. You know, there's there's such a runway. So many things we want to get done, but, but it's an exciting ride. Even despite the challenges of inequalities, because in this space, the opportunity to make a difference is so tangible.

00:45:57:06 - 00:46:30:16

Keerti

Yeah, well, Christiana and I need you to do my job to stay inspired. So, you know, it's a it's equal connection. But what I'm also hearing from you, which is something that I'd like to look into more when we think about inequality and health inequality is acknowledging our privilege you know, acknowledging that there would have been a start in life that was so different to our parents or different to other people who are minoritised in this country.

00:46:30:18 - 00:46:50:10

Keerti

Because I was listening to I think was I don't listen to the Woman’s Hour often, actually on Radio 4. But I was listening to it and there was somebody and so I'm not going to know who, but there was somebody talking about it was a white, middle class woman. She sat in politics and I think she'd gone to a grammar school, but she was saying, you know what?

00:46:50:10 - 00:47:15:24

Keerti

Me as I white woman who does sit in a position of power, we need to we need to acknowledge the position wherein rather than kind of have this narrative of we deserve it because that we might deserve it because we worked hard. But often we hear this, this story of, oh, you know, when I was growing up, I went to a state school and, this happened to me, that happened to me.

00:47:15:24 - 00:47:44:16

Keerti

And although that is all relevant in someone's story, I'm not negating that at all. It's as if we need to have an excuse to feel we deserve where we are something. And I, you know, and I it's a it's an interesting one because we have some, I mean, I, we're interested to really figure out what the challenges are when you navigate the UK system or any system of why people will suffer greater inequality than others.

00:47:44:16 - 00:48:05:22

Keerti

And we know that there’s an aspect related to race and deprivation. Absolutely. In north west London, and that is a key area to try and understand that and how, you know, deprivation just completely disables your ability to socially mobilise, right. And so we need to acknowledge that some of the things that have given us not only privilege but grit.

00:48:05:22 - 00:48:28:10

Keerti

So part of our privilege, I think, is this sense of ourselves. It's this grit that we have. And actually, it's beautiful, isn't it beautiful? And we want to pass that on to our children for sure. When we want to think about how we enable others who who have that sense of less value to come on, you know, you can be powerful if you want to, and you need to think about how the world is making you feel.

00:48:28:10 - 00:48:31:23

Keerti

But you know, I don’t know, what do you?

00:48:31:23 - 00:48:54:24

Christiana

I think that's very interesting. So in terms of privilege, I, I look at it in two ways. Firstly, when I think about my story, I was very aware of because, you know, Lagos, I mean, people, people think about Africa as poor and I know there's a lot of poverty, but there's also a lot of wealth. And my parents were very, very well, very, very wealthy.

00:48:55:01 - 00:49:36:06

Christiana

So growing up in that sort of caged environment, but very, very close to poverty because it's it's so vast as well. There's no way you wouldn’t see people, when you're driving on the, on the bridge, for instance, you know, a lot of begging or under or living on the river and things like that. So I was very aware from a very young age that I had a level of privilege that I had not worked for zero to do with anything I had done. Simply by being born to this particular man and woman who also highlighted the poverty they came from and the opportunities they then got that moved them to, to be able to create

00:49:36:06 - 00:50:01:22

Christiana

for us what they had done. So I knew from three, four that, you know, absolutely privileged, in a way that is not fair, because it's not. When I say fair, it's not to do what I did versus another 3 or 4 year old being born to someone else. There's that then. And that also comes with obviously some level of I mean, for instance, I came to the UK to a boarding school

00:50:01:22 - 00:50:24:01

Christiana

that was very expensive. I have no student debts, you know, because it was all international fees paid. You know, those sorts of things. But on the other hand, I also have the privilege of growing up in Africa, meaning I have a sense of my Africanist that is not the same, that most people who grew up here have. It's not something I have to explain.

00:50:24:01 - 00:50:42:01

Christiana

I can write a thesis on it. It just is. It's in my very, you know, you called me, I believe, Nigerian, and that's literally me. So that and that sense of groundedness in who I am is a privilege because it's not the same as a child picked up at two and moved here and, you know, all of that stuff.

00:50:42:06 - 00:51:01:22

Christiana

So there is the privilege of even within being African and an immigrant, very different from others who may have come from that. So I try not to. And this was highlighted to me actually, by Kevin Fenton. I was at a meeting where he was at as well, and he sort of we got talking and he sort of said, yeah, you know, I should be aware of that privilege.

00:51:01:22 - 00:51:27:14

Christiana

And it's true because he he said he also grew up, I think, in the Caribbean and came here as an adult, which means he was quite secure in his Caribbeanness I suppose, if you put it in that way. So I do think that there's a difference there and one that we need to be aware of. And also even even apart from those obvious things, having someone like maybe Graham Thompson, make it call for me.

00:51:27:16 - 00:51:53:01

Christiana

With regards to my first ophthalmology job, those are of things. Again, that's a privilege because they not many people from my background have people that are very senior in their careers or field speaking up for them in those rooms where you're not at. That's a privilege. Regardless of your background, really, that someone champions you when you're not there.

00:51:53:07 - 00:52:21:03

Christiana

That's a privilege, that I'm very acutely aware of. And I try to that particularly because now I sit on decision making things and I try to speak up for those that I know, nobody will ever even think of them. I, I always feel like, look, I don't think this person's name will be mentioned, but I actually think they're really excellent and blah, blah, so that I think suddenly at the stage I'm in now is a privilege I'm even more aware of than I was before.

00:52:21:05 - 00:52:44:15

Keerti

Christiana you can see it from the way people interact with you and I really hugely value, you notice that sometimes when you are doing something and as physicians, I think actually and as junior doctors, I think one of the challenges in the NHS is that often in medical school you're validated, aren't you? And then you get to a career and you do your job and you really have to validate yourself, you know?

00:52:44:15 - 00:52:57:01

Keerti

Yeah, I mean, you have to validate yourself. You have to feel good about it because otherwise, you know, you don’t get it anywhere else. And I, I like to instill that in my kids as well. You need to learn to validate yourself as well. You don't always get it from others.

00:52:57:03 - 00:53:16:06

Christiana

My husband was saying this, just a little story, saying this about my son because he plays in the in his eight plays in the 80 minutes school football. But like when he saves, he's a, he's a keeper. When he saves a goal or whatever, he just saves it. And my husband’s like you need to hold the ball and just stand and just revel in it.

00:53:16:08 - 00:53:39:23

Christiana

My son is like ‘get away, daddy’, it's like, no, no, no. You know, this is a big thing. This is the showmanship of being a goalkeeper. And my son is like ‘no way’. So my husband is even more self-assured than I am. So there is that element of just celebrating. Just, just, just, you know, sometimes when no one else cares, frankly, about some of this stuff, no one else cares, but you do.

00:53:40:01 - 00:53:51:04

Christiana

So there is that sort of it's good enough for me to celebrate that I did this thing, or I achieved this thing, and I am the bee's knees because it happened before.

00:53:51:06 - 00:54:13:05

Keerti

We both celebrate actually being physicians. You know, I think one of the greatest privileges of my working life is the is the numbers of patients you meet and the stories they tell you and the privilege of learning from them. I mean, you learn from people and patients in a way that I think as you get older, you realise how phenomenal that is, really.

00:54:13:05 - 00:54:34:00

Keerti

I mean, and so I think that way that we can feel satisfaction in your job. No, but, Christiana, listen, it is important you you hear it and I'm sure you do hear from others. But when I work with you, for example, I've had, you've been open about feedback with others in the room and it makes a difference. And you do it with energy as well, you know?

00:54:34:00 - 00:54:39:23

Keerti

So there are so many things I could ask you, Christiana. And I think we're going to have to have another conversation because.

00:54:39:24 - 00:54:40:20

Christiana

This was really good.

00:54:41:01 - 00:55:11:21

Keerti

Really interesting to have these kind of open conversations with different people. But people who are willing to share, you know, we need. You're comfortable. And I I'm a strong advocate for that need for whatever our background is, to share it and to share something of ourselves. I think the power of that is so important and hearing what you're saying and let's say, reflect that from a story from from someone that I know is very different, you know.

00:55:11:23 - 00:55:31:01

Keerti

And I'll give you an example. I have, we have been trying to get a young nursing colleague who is a woman of black ethnicity, and I know her journey has been different, you know, and I think I would love her to be able to share that. And of course, there's anxiety. So there is an acknowledgment. I know that we're not going to hear the narratives of people yet

00:55:31:01 - 00:55:34:21

Keerti

that are important to hear from. Christiana, listen thank you so much

00:55:34:21 - 00:55:38:21

Christiana

Thank you.

00:55:38:23 - 00:56:02:02

Keerti

This was an episode of the NIHR podcast, part of our EDI series, Conversations to Cultivate Change. I'm Keerti Gedelha, and thank you for listening. For more information about the NIHR, you can visit our website - nihr.ac.uk.