"Be Mindful of Who You Are Serving" - Lendri Purcell and Althea Hicks, The Jonas Philanthropies

DR. RISHI DESAI: Hi, I'm Dr. Rishi Desai. Today, on Raise the Line, I'm happy to be joined by two guests who work for the Jonas Philanthropies. The work from Jonas focuses on healthcare for nurses and veterans, children's environmental health and the overall health of the climate. I'm really looking forward to learning more about what Lendri and Althea have to say. Thanks both for being with us. Lendri, maybe we can start with you. Can you just give us a bit of an overview of what Jonas Philanthropies is and its mission for those that may not know much about it?

LENDRI PURCELL: We are a charitable fund and our mission is to help Americans in need of access to quality healthcare by focusing on innovative strategies that are evidence-based.

DR. RISHI DESAI: Althea, what would you add to that definition?

ALTHEA HICKS: Well, we try to meet America's most pressing healthcare needs, so we work in a lot of different areas, including environmental health, and then the nursing, veteran's healthcare, vision and other areas as well.

DR. RISHI DESAI: Lendri, do you mind just walking all of us through the path you took to getting to where you are now as vice president?

LENDRI PURCELL: Sure. I have always had my heart in social service work. I started with Teach for America. I was put in Oakland where I was a special ed teacher. Then I got my master's and two teaching degrees.  I got a call from my grandfather that he was going to start a charitable enterprise. He was going to auction off some art that had appreciated in value that he'd been very proud of and he had had over the years. 

As he was moving into retirement, he wanted to give back and do something great for the world so he asked if I wanted to join in somehow and he gave me sort of a small budget at first to focus on at- risk youth in the East Bay area, which is what I focused on -- youth mentorship, school to work programs and different issues. Then I went to work for Price Charities in San Diego and I slowly have been building my skill set from there and just stayed engaged. I've always pushed just to be as broad- thinking as we can and as progressive as we can. It's been a great journey.

DR. RISHI DESAI: One of the things that I always loved about this story is that one big core pillar was nursing and veterans affairs. Can you tell us the background on that and why that was meaningful to your grandfather?

LENDRI PURCELL: Sure. Originally, we knew he was going to auction off the art and the money was going to go to charity. At the time, I was really pushing for education because I was an educator and honestly, a lot of money at the time, a lot of philanthropic dollars, were going into education. Eli Broad was doing a lot of funding and the Charter School movement was taking off.

My grandfather had a great experience with a nurse who helped him, and he was always so forward thinking. He just thought, “This is a group that I want to support.” He was always looking for an uncharted beach, and he said “Here's a cohort that touches all of us in society.” He wanted to see how he could be of service to nursing.

DR. RISHI DESAI: Althea, how did your path wind up crossing with Lendri's?

ALTHEA HICKS: Well, Rishi, my background is in public health so when I graduated college, I went and worked with Memorial Sloan Kettering Cancer Center. There was a program with the National Cancer Institute, then I also moved into Grants Management so that's how I became involved in research. 

Also, I moved on to eventually earn my master’s degree in Public Health and my doctorate in Education. In doing that, I was looking for a position that actually allowed me to combine all of these skills together so when I found out about this position, I applied and went through the process and thankfully, here I am. That was a great experience and it really has helped me use all of my skill sets from those areas.

DR. RISHI DESAI: What is it like working in big organizations and then more nimble, small organizations? Do you feel like, as a person, you resonate with one versus the other?

ALTHEA HICKS: Well, I see the differences and I can definitely appreciate them. One of the things that I think is important to realize with our program is that although we, for example, have a small team, or they may not be on the level of the other organizations, the program is a national program and we've expanded all across the country so it's still a large scale program in the sense that we're working with so many different people on different levels.

DR. RISHI DESAI: Now, one of the things that I've always been struck by, Lendri, is it feels like in conversations that we've had in the past, you're always thinking two, three, four steps ahead. One thing that you're often talking to me about is children's environmental health. Do you mind speaking of how that even got on your own radar and why that's a passion for you?

LENDRI PURCELL: Sure. When I had my first child -- gosh, 10 years ago now --  I knew that I wanted to live out of the city. I was concerned about air pollution. My husband was having some asthmatic symptoms and I had read a lot about early exposure to poor quality air.  And then we had an issue where at my son's six month medical appointment, he was tested for lead exposure and he had pretty high lead levels.

At that moment I sort of took a deep dive into every other possible exposure that we could be having as a family, and I learned that there are so many exposures that we're exposing ourselves to as pregnant people and our children too, and that became a deep passion area for me.

DR. RISHI DESAI: I think a lot of people assume living in the U.S. --  I certainly take the assumption --  that things are safe if they're in my home. That the water is safe, the food is safe, et cetera. What have you learned on your journey as you've taken a deep dive on this?

LENDRI PURCELL: I've learned that there are over 85,000 synthetic chemicals in common use in everything from our mattresses to our water, and less than 2% have to be tested for health and human safety. The way that the system works in this country is that things are put on the market, and then we wait and see if there are problems. The burden of proof to show that there are actually significant health problems is really, really high to the point where we haven't even been effectively able to ban Asbestos. We're living in this toxic soup. 

We can tell from the teeth of our babies. There are studies on umbilical cords -- we have these exposures, and then in a lot of cases, we don't know what the effects are, but in many cases we do. There's so much work to be done in preventing exposures and changing our chemical policies. At this point, a lot of it needs to be market-driven because it's very hard in the political landscape to ban a lot of these chemicals, so a lot of it is about consumers asking for safer substitutions.

DR. RISHI DESAI: It definitely feels like things have shifted. When I was growing up, my mom used to cook food for me in plastic bags. Now, “BPA free” is something that even my mom looks for on a label. That's just a small data point, but I feel like consumers are moving to be more conscious of this. Is that your sense?

ALTHEA HICKS: I think it is, and I also think that now that we have these megastores, change can happen pretty quickly.  Like when Target decides to get rid of their plastic bottles based on consumer demands and move back to glass, there's a huge market shift there. A lot of the grantmaking that I'm doing is on groups that are educating stores that want to change their policies. 

Because there are these 85,000 chemicals, we're looking at classes of chemicals instead of whack-a-mole trying to hit them all, so if you can ban the worst classes of chemicals that's a good place to start.

DR. RISHI DESAI: Althea, would you mind speaking to the Veterans Program that Jonas supports and spell out to folks the key things that you see and initiatives that we need to be thinking about?

ALTHEA HICKS: Well, for our program, we fund doctoral-level nursing scholars and to date, we funded over 1,200 scholars around the United States. A quarter of those scholars are scholars who have focused on veterans healthcare or scholars working to improve the healthcare in the veterans health community.

One of the key issues that we often see, which has become more current recently with the MISSION Act over the past year, is that many of the veterans get their healthcare in the community, but the practitioners in the community or the nurses in the community may not necessarily understand some of the issues that the veterans may be encountering in their health. So we are working in the veterans healthcare area to try to improve the education of those nurses and the experience so that no matter where a veteran goes to get their healthcare, there's a nurse there that understands the particular health concerns that that particular veteran might be experiencing, whether it's at a veterans administration health center or a community health center.

DR. RISHI DESAI: Well, what's an example? I know, for myself, when I think of a veterans issue, the one that jumps to my mind is PTSD, but walk me through what are some of the gaps in understanding and knowledge that these nurses have that then lead to poorer care?

ALTHEA HICKS: As you mentioned, PTSD is a very popular one so to speak. Many people are aware of that. There's also one of the issues related to the family. We've had scholars studying basically how to address the family of the veteran. They may not understand the little details about having a family member with PTSD and the nuances of what that lifestyle is like. And then also issues with children who may be a part of a military family, and they may be moving around from time to time and they may not have a consistent healthcare record. So that's something that many nurses who  may be caring for children should be aware of if they are children that may be part of a military family.

DR. RISHI DESAI: One of the themes between both of your lines of work and the things that you're talking about are lack of knowledge or training in the formal, traditional sense. Do you feel like there are places where that's changing? Can you point to some examples where there is more training about these issues? What are points of optimism, perhaps, for both of you?

ALTHEA HICKS: One of the things, I would say, is that I believe many professional organizations are actually developing more trainings, webinars, and seminars. They're including many of these in their conferences in terms of identifying these particular subject areas and bringing in experts who have more experience in these areas to share these concerns and practices with their colleagues in the health field. I think that's definitely one example. 

Also, I think many nurses are using social media, and I think that's also something in the health arena that is being underestimated whereas social media is being used by professional organizations, many healthcare professionals of all realms, of course, and consumers. This is another area where there are different topics being shared, different resources being shared, and so it provides more of an opportunity to obtain this education.

LENDRI PURCELL: I was going to go in the same direction, but with an environmental health lens. It feels like there's less siloing among groups. Mental health groups now are really interested in the mental health impacts, in the increase in ADHD, different impacts from neurological chemical exposure so there's more connection, just more connections among disparate groups that see how children's environmental health, the education system is affected by these exposures. All of a sudden, social media has opened up a lot in terms of connecting groups, and there are a bunch of “mom blogger” types out there, and some are more focused on science and some aren't. 

I've started a group, FACTS -- Families Advocating for Chemical & Toxics Safety -- that’s like a clearing house. So we show toolkits on how to keep kids safe if they're at school, in their home, from these toxic chemicals. There are more groups popping up and more and more are really focused on science and evidence-based science, and you can access them through social media. That's pretty new.

DR. RISHI DESAI: One common criticism of social media is that it silos communities quite a bit. The people that buy into things then learn about stuff, but then the people that don't get that same exposure don't learn about it. With things like this, do you feel like that's happening or is it quite different where you've seen across the board nurses and other clinicians are really learning more and more about veterans and about environmental toxins?

ALTHEA HICKS: From what I can see, I think that they are definitely doing more collaboration and even you see when they are building on their products, are building on their resources, that they have professionals across different areas. I think that's one of the key things that is actually becoming more important, to have this collaboration in terms of getting more information available to everyone.

LENDRI PURCELL: One thing we're doing at JNVH, at Jonas Nursing, is to have ongoing webinars on different topics that are offered to all past Jonas scholars so they can at any time learn about any topic, any new topic related to environmental health, related to veterans. It's open to all of the scholar community, and we're making those webinars open to all nurses as well.

DR. RISHI DESAI: You touched on my other question, which is nursing faculty and teachers. Obviously, they are kind of a force multiplier for education. Have you gotten a lot of warm reception from faculty that want to learn about this stuff, but don't feel like they have good access to quality information?

LENDRI PURCELL: What would you say, Althea?

ALTHEA HICKS: In terms of the faculty, it's been interesting because we find that at this point in our program, many of our scholars are faculty or in a faculty position so it's still needed. There's still a need and whether they are seasoned or brand new, it's something that we hear across the board from not just scholars, but also our colleagues at other professional organizations that there is a need for faculty development and it also crosses degrees. 

It doesn't matter if it's in the nursing practice, doctoral nursing practice area or the Ph.D. research area, there is still a need for faculty development. That's one of the things that we are working on as well, trying to identify how we can continue to provide more opportunities in this area.

DR. RISHI DESAI: Along those same lines, do you find that the challenge for faculty is that they feel like they can't teach this effectively or is it that they just don't feel like they were trained themselves? Obviously, you're talking about things that are now known that were maybe not known a generation ago. Can you just help me understand where are the sticking points with faculty and when you find those?

ALTHEA HICKS: What I've been hearing in terms of the faculty and where are the gaps, maybe, is one of them is not just the knowledge base. For example, we know data changes every day. We've experienced that just even with the current pandemic -- news that we had a month ago is now different from news we have today. 

Then there is also the actual ability to relate to the students.  We find that sometimes there's a gap in relatability depending on ethnicity and diversity with the scholars or the subject matter or population that they may be serving in nursing. This is also an area where we are still working to try to support that area of increasing more faculty and more diverse faculty so that we can close that gap. Those are two things that I would think about as far as what causes that disconnect. 

LENDRI PURCELL: I think, in terms of environmental health, one thing we're trying to do is have a better curriculum for nursing faculty about environmental health issues so they have good information that's tailored to their audience. That's something we're looking at from a grantmaking standpoint, and we've done some work with UCF on environmental health curriculum for nursing faculty and for medical faculty as well.

DR. RISHI DESAI: We're speaking in late July and we're in the middle of COVID, in the throes of it. There's been a huge spotlight on both education as well as healthcare and you guys are obviously at the crossroads of both with your training programs. What are some the of things that you're seeing that are new that weren't conversations that were really happening six months ago?

ALTHEA HICKS: Well, unfortunately with, of course, not just the pandemic, but all of the social injustice occurrences that have happened now, there's more of a focus of diversity and inclusion. While I think that was happening several months ago, I think it didn't get as much attention. You didn't see as many events or attendance at as many events. 

Now that's definitely one thing that I would say is very prominent in terms of the new conversations. This is something among faculty, among students, among the nursing community. I think you see it almost everywhere now in the healthcare profession. Everyone is identifying the health disparities that have come, or that have actually been occurring for a long time, as we know, and then also the health disparities just within the nursing community or the social injustices just within the nursing community. 

LENDRI PURCELL: I would add to that from the larger perspective of the fund, we're thinking a lot more about what the leadership looks like at the groups that we're funding. Is there diversity and  inclusiveness in the leadership? Same thing for who we are invested in as a fund, making sure that all of our investments are with groups that are aiding a fair and inclusive society. So we’re trying to infuse that ethic into everything we do moving forward.

DR. RISHI DESAI: Yes. That makes sense. I totally agree. It feels like maybe where sustainability was something that we all started thinking about maybe a year or two ago, DEI, is something we're all much more mainstream thinking about today, to both of your points. With that in mind, I guess one thing I wanted to flag is that a lot of our learners or listeners are future healthcare clinicians, or they're going to be public health leaders like the two of you are.

Do you mind sharing a little bit of advice perhaps for someone that's just starting in the field and they see the two of you who are obviously well accomplished in your respective areas. How did you get there and how does someone that's just starting out follow in your footsteps?

ALTHEA HICKS: One thing I would say is remain persistent and definitely identify where you not necessarily just think you should be or think you want to be, but also be open to new opportunities as well. Sometimes, the opportunities don't necessarily come in the way that you expect them. While you should have a goal, have a pathway, have a plan, just be open to some of those new opportunities that might also be able to adjust your plan so that you will see the place where you thought you might want to be, you can actually get there sooner, or you might get something even better. Just be open to that. 

I would definitely also suggest being mindful of who you are serving. We talked about social justice and diversity, and I think that spans around the country. No matter where you are, if you're in a rural area, or if you're serving a specific population, always be mindful of your audience, because those are the people that you're serving in whatever capacity that you're serving, and you want to make sure that you are meeting their needs and you have the skillset to meet their needs. Those are the things that I would say to someone who's working their way in their career.

LENDRI PURCELL: I guess what I would add is the same thing -- being really flexible. I thought I was going to do education, then this window opened to philanthropy, and now I’ve become sort of an advocate and an activist in environmental health. Be open. You don't know where your path is going to lead, but cultivate mentors along the way and make sure you're keeping a list of people that can support you and keep up with those people because you never know when you're going to need help and support down the road. So, find your mentors.

DR. RISHI DESAI: As you think about your career, do you think of mapping out the next three years, or five years out? What's common for you?

ALTHEA HICKS: I don’t think about tomorrow. (laughs) At one point, I used to be very long-term where I would try to think, “Oh, in five years, in 10 years, I'm going to do this,” but with the current situation and the way things go, while I still have some long-term goals, I try to really plan more in the short-term because I realized that what happens in the long-term is based on what I do now. If I focus on what I do now, then that will help me accomplish what I want to achieve in the long-term.

LENDRI PURCELL: I am looking around my desk because I sometimes have like a mind web or a little visual to help keep me on point, where I want to go. I feel the same way as Althea. Maybe it's partly COVID, but just in this moment, what I'm doing and trying to focus on is the importance of this moment and see where it leads because you never know. Things keep changing. I used to have a really long window. Now it's like a year to five years.

DR. RISHI DESAI: It sounds like the theme is carpe diem, so seize the day. I really appreciate having both of you on the show. Thank you Lendri and Althea for joining us. I'm Rishi Desai. Thanks for checking out the entire program. Remember to do your part to flatten the curve and raise the line. We're all in this together.