Expert: Building Resilience Can Help Dismantle Structural Racism Within Health Systems

Pharmacy Times interviewed Vibhuti Arya Amirfar, PharmD, MPH, on her keynote address at the 2022 Advanced Topics for Oncology Pharmacy Professionals (ATOPP) Summit on building individual and systems resilience to dismantle structural racism.

Question: Why is resilience such an important element of dismantling structural racism?

Vibhuti Arya Amirfar: I think that when it comes to resilience, particularly, first of all, I want to acknowledge that I think a lot of people are sort of getting tired of hearing about resilience, because we've talked about it so much on an individual basis, like, here's what you should do to kind of control and mitigate some of this harm or factors that you're dealing with, particularly as all of us go through collective trauma of the pandemic, and very specifically just sort of being disrupted in our lives. But I think that one of the things that's really important to understand about resilience is that it really helps us to decrease the propensity to, for example, for illness, anxiety, etc. It's really important for all of us to see how we can become a little bit more resilient in terms of dealing with our own lives, but also from a systems level, right? Like, how do we provide the environment that actually allows all of our team members to not only just survive, but also thrive at their best ability within these work systems and environments where we're really asking a lot of them to show up day in and day out, and, oftentimes, frankly, do a lot more than just their sort of job description on paper?

So, it's the idea that no matter how much I take on, I have to develop healthy boundaries, I have to think about ways in which I need time to recover from processing things, not only that are internal to me, but also our environment, our community, or society, and the world at large. So it's really, really important for us to understand the history, the harm, the systems, sort of pick that apart and be able to recover mentally, emotionally, spiritually, so that we can enter the space asking for more conversation, deeper conversation, more meaningful impact and exchange, and then work towards dismantling structural racism. Because, if we're going to get very bogged down and not be able to recover, we're not going to have the capacity to actually move these systems, and frankly, just ourselves through these spaces of trauma, towards a lot more healing that is needed for us to actually pave the way for really meaningful work to be done in this space.

Question: Can individual and systems resilience be implemented through practices in work environments or are they more internal and reflective processes to engage in?

Vibhuti Arya Amirfar: I think you asked the right question in terms of having that sort of dual approach. I think it's a multi-pronged approach. So there's who am I as an individual, what am I going through, how do I take a beat to understand how I'm being impacted by everything, and I can still show up and be functional and effective and be held by my community, either at home or at work or the places that we find ourselves in. But also, from a systems perspective, how do I cultivate through policies and procedures just sort of more of a culture shift to understand that these are people, not just metrics and data and numbers that we have to employ within our systems. I often ask folks to think of a way that we can structure ourselves a little bit more as a collective and as a community, because as each of us get impacted, we need to really be importantly, checking in with each other checking in with ourselves, but there is absolutely a way for us to harmonize a little bit in terms of really getting those systems prepared to deal with people, right.

If we don't have a people-centered focus, we're just going to see these problems amplify over time and ebb and flow. Because we're not metrics, we're not data, we're not just tasks and objectives and goals. We are actually people, and we have to be able to work with that to be people-centered, so that we're actually caring for each other and ourselves through these work systems and spaces, particularly in healthcare, where we are called to care for others, to care for so many individuals and again, like I said, play roles that are beyond our job description. Particularly, when we look at dealing with other humans, it's my stuff, then somebody else's stuff, and then how is this system actually facilitating a fruitful exchange so that we all can benefit from it and be healthy wherever we are in those systems.

Question: How might structural racism within the field of oncology pharmacy impact issues that might lead to oncology pharmacists leaving the field?

Vibhuti Arya Amirfar: I think that one of the things we're noticing in workforce trends across sectors are certainly this what we now know to be sort of that Great Resignation or the Big Quit, or—there’s several terms for it that are being used. But I think that the convergence of sort of the social justice movements in the last couple of years plus the pandemic hitting, and for those of us who have privilege to sit at home with stable housing and stable food and relationships and community to sit there and reflection and really absorb and understand how we can process all that's happening. Then also just really realizing that having access to social media and information at your fingertips being home from the pandemic, and also really understanding how social justice has risen to the main stage of conversation, it allowed a lot of us to think about and reprioritize how we can live our lives and things that we can be intentional about.

I think a lot of people through the workforce across various sectors are leaving jobs that are requiring too much of them, that don't allow them to care for themselves. I think in healthcare, particularly we face a lot of this, “well, you knew what you're getting yourself into,” or healthcare providers are supposed to be martyrs, by nature, or whatever. I think that there's a real need to think about mental health, behavioral health, how are we caring for ourselves before we can care for others. The work system pressures, I think, have been abundant in terms of really responding to the pandemic, but also just our patients’ needs. I say that sort of the baseline level of anxiety in the world has just kind of increased, and a lot of us are feeling this collective trauma. So, it's important for us to realize that the harm that has been done through our history, or, frankly, through our current existing policies, laws, procedures, even within our work environments, can really cause people a lot of trauma and give them that sort of push that they need to just leave a work environment, because it's just too much.

I think that there are a lot of conversations, thankfully, that are coming to stage now more than before, that we ought to be paying attention to. But I think the conversation around how we can heal through a lot of trauma, if a workplace is not suited for it, if an environment or a field, in a high level aspect, like a system or workforce itself is not equipped to handle it and to really have discourse, then we’re going to see a lot of people leave because a job is not just a job. It’s our environment, it’s where a lot of people spend their time. And if their environment is not nurturing for them mentally, physically, spiritually, it’s going to be really difficult to kind of retain a lot of employees, right? That we think about, it’s not just about survival, right? It’s about—you want everybody to be able to thrive in their workplace. I think that oncology pharmacists, similar to many others, are facing this challenge where their demands are quite a bit, and these work systems that have traditionally looked at people as metrics need to refocus and reexamine how they’re putting people first. That would actually help their workforce be happier, and not just like happy in terms of needing everything from your job, but just going to an environment where you know you’re cared for and that is nurturing.

Question: You are involved in some prominent national and international organizations in the field looking to address issues relating to diversity, equity, and inclusion. What led you to become involved in this work in this area of the field—was it something you were interested in when pursuing a PharmD, or was it a direction your career took once in the field?

Vibhuti Arya Amirfar: Yeah, I actually started before I went to pharmacy school, so I was engaged in a lot of social justice, sort of initiatives, and activities. As I was growing up, I'm a first-generation immigrant, and I grew up in Washington Heights, New York, before it was a musical. A lot of those spaces were very affirming for me, just for my own identity as a woman of color and as a first gen immigrant. So, there's a lot of life story and lived experiences that led me to this work before I knew that's the work that I was doing, just because of the spaces I was in and where I was finding myself to be heavily engaged in. So I brought that with me to pharmacy specifically, because I actually thought, there's a lot of access to care issues, particularly in communities that have low socioeconomic status, particularly communities of color, and especially immigrants who were just very scared to even show up to the doctor's office or engage in health care, frankly, because of fears of being deported, fears of litigation, etc. There’s a lot of nuanced factors that, that contribute to how I got in here.

But also, I'm very glad that I stayed because I think for pharmacy, it was a very clear link for me in terms of access to care and public health, which is where I found myself moving through in my career. And it's really, really important for me to be engaged in shaping, not only the local and regional but also national and international conversations around diversity, colonialism, how do we decolonize even the way that our work systems are set up, the ways that we even we teach, and that we think about our jobs and ourselves. There's a lot and lot of layers of all this work that I find myself sort of thrown into, because it's part of who I am. It's what I love to do, and although it's quite heavy and emotionally labor intensive, I find it also to be very fulfilling. Finding the power of the collective where you can really bring people together from all walks of life who are committed to bringing this change can be really a beautiful and powerful experience.

Question: Is there anything you’re working on right now that you would like to highlight?

Vibhuti Arya Amirfar: Currently, I'm engaged in a lot of initiatives with national organizations, as well as the International Pharmaceutical Federation, or FIP, in really thinking through ways in which we can bring issues of diversity to the table, think about ways in which we can get members involved, particularly from a systems lens. So, rather than just focusing on the conversation about individuals, we're really talking through how do we bring brave spaces where we can actually move the conversation in creating systems and environments. So, pretty high-level big picture thinking, but really also very exciting, because I think that systems-level thinking is sort of where my brain goes. But it's really important for us to understand, so we're not just putting the onus on individuals all the time, but that we're actually saying that individuals need to do the work, but how do I also create and shape the system to actually facilitate that work and be a conduit, so that we can actually have more evolved conversations and think through ways in which we can work through policies, work through hiring, work through practices, and caring for our patients and caring for each other with a lot of that sort of mindfulness and resilience in mind, that's not just saying that the individuals need to do the work, but that the systems are committed to facilitating some of that work. We're going to be, for my side, sort of working with a collective to really look at some storytelling initiatives that might bring a lot of these stories to light so we can engage and share and raise our collective awareness, but also raise our collective advocacy work around this issue, which is really exciting.

Question: What are you looking forward to at the ATOPP summit this year?

Vibhuti Arya Amirfar: I think I'm actually really excited to hear some of the conversations that are going to be going on at ATOPP, particularly within some of the smaller talks around hiring and advocacy and representation. I know that this has been a focus of the summit. Honestly, I just really hope that we can inspire more conversations, so those who are in attendance can actually come through and allow themselves some of the intentional space and time to have these conversations to deepen their own understanding, but also to step into their agency on how they can actually move the needle within their systems to impact change towards a more equitable future.