Black Maternity Natters: Ep 4 - Dr Karen Joash

In this fourth episode of Black Maternity Natters, Ann Remmers sits down with Dr Karen Joash, an award-winning Consultant Obstetrician and Gynaecologist at Imperial College London. In a deeply moving conversation, Karen reflects on the "miracle of birth" and her lifelong commitment to supporting women through their most vulnerable and joyous moments.

Karen shares her own journey of resilience, from applying to medical school three times to navigating a healthcare system where she rarely saw herself represented. This personal history fuels her urgent work in health equity, particularly her exploration of "weathering" - the process where the chronic stress of racism leads to accelerated metabolic aging and poorer outcomes for Black and Brown mothers.

The discussion dives into how we can move beyond the "blame" often found in research data to address systemic barriers. Karen talks about how her team at Imperial successfully achieved equitable hemorrhage rates in just three months by challenging clinical biases, such as learning to recognise physical signs of blood loss that are often missed on darker skin.

Beyond the clinic, the episode explores the power of diversity of thought as a "gift" that fosters safer, more innovative healthcare systems. Karen also offers a preview of her upcoming project, "The Black Women’s Health Bible," a book designed to provide actionable solutions for the gender and racial health gap.

Join us for an inspiring conversation that challenges all of us to consider how embracing diversity can lead to greater peace, impact, and joy in our own lives.

Programme notes

Black Maternity Matters

Dr Karen Joash

NHS Race & Health Observatory

Tommy's - the pregnancy and baby charity

Rebel Ideas: The Power of Diverse Thinking by Matthew Syed

Connect with Dr Karen Joash on socials: Instagram and LinkedIn

Connect with Black Maternity Matters on socials: Instagram and LinkedIn

Got feedback or an idea for a future programme? 

Contact us at healthinnowest.communications@nhs.net or via our socials: Instagram, LinkedIn or Bluesky

Find out more about Health Innovation West of England

Transcript

Ann Remmers Hello and welcome to our fourth Black Maternity Matters podcast. I'm Ann Remmers, I'm the clinical lead for Black Maternity Matters at Health Innovation West of England. And I am really delighted this afternoon that I have in my studio doctor Karen Joash, who is a consultant obstetrician and gynaecologist at Imperial College, and many, many other things as well, which I'm sure she's going to tell us about. So, Karen, welcome. Very lovely to have you here. Can I just start by asking you to tell us a little bit about Karen Joash? You know a bit about your background. What makes you tick?

Karen Oh, I'd be delighted to. Lovely to be here with you all. I am very, very blessed to be a doctor working in obstetrics and gynaecology. So, seeing, the humanity at the very start of life, seeing humanity when it's under pressure with pain, supporting people in their relationship in that time with each other, supporting mothers to birth well, and then also supporting women through their whole life course when they may have reproductive issues all the way from periods to fertility to menopause. 

I just love taking care of women. so that's my main clinical focus in my clinical focus. I've got some specialist areas. I love perinatal mental health. Again, maybe I'm somebody who always likes looking and supporting people through difficulty. And I've championed the development of networks across London and the UK and also of course director for the RCOG, the Royal College of Obstetricians and Gynaecologists annual perinatal mental health course. 

I also loved taking care of women post-delivery. So, I'm very interested in post-natal care and also perineal care. So, helping women's pelvic floor to recover, not to have long term damage and to really support them through that transition. So, I've helped to set up clinics across north west London, which have been able to deliver really good care, so women recover back to full function. 

And then I also help women in the context of gynaecology around heavy menstrual bleeding, and abnormal bleeding. So, if they need any checks with regards to, possible cancer.

And I love leadership roles. I think the healthcare ecosystem can be changed when we have diversity of thought, when we include people around the table need to be there. So, I've done that throughout my whole career and I've been involved in educational leadership, and I'm currently lead on education across London for doctors in training, as well as recently, I've been appointed to the Clinical Academic Training Office at Imperial College, and I'm director of that as well.

Ann Remmers Karen that - I mean, I knew you were busy, but that is just that is just incredible and how you do it and with such, sort of calm and grace, is hugely impressive. And I just be curious, what led you to a medical career in the first place? Was there anything particular? Someone in the family?

Karen It's a really good question. In fact, I think a long time ago they asked me in Stylist to do an article on this about the NHS. And both my parents were nurses in the NHS, and I always remember skipping along the wonderful Victorian hospitals in that day. They looked beautiful in the, in the seventies. And then, you know, my mum used to wear the lovely hats and the capes, and then my dad wore a white coat. It just seemed like such a, a wonderful career to be in a place to be able to care for people It was just, it looked wonderful. And I thought, yeah, that's what I want to do. And so my parents tell me, I always used to have stories of sitting down at the age of four with a newspaper saying, I'm reading because I'm learning to become a doctor. So.

Ann Remmers That is adorable. So lovely. What a lovely, way to be encouraged into that career. and what was it that led you into obstetrics and gynaecology? Because, you know, I know that you would have had a choice, you know, of going in many different directions.

Karen Mhm. I think for me, it's just an appreciation of that the miracle of birth is what, the first thing that drew me to obstetrics and gynaecology, where we recognise that we're all one and the same in terms of humanity. it brings us back to a real sense of grounding, to recognise that some people can have an easy time, some people can have a difficult time, but actually they can be held by the connection of the care giver that surrounds them. they can be connected through joy. They can be connected through sorrow. and it's a real bonding experience, not just for the mother, the father and the child, but also for the person that surrounds and holds them in that experience. And I very much wanted to be part of it. I know I can remember as a medical student seeing the first birth of a woman, you know, pushing with such grace and strength. And, you know, the perineum expanded, the head came full, you know, beautifully. And this wonderful baby came out and cried. And I thought, wow, that is just so miraculous. I want to do that every day.

Ann Remmers Oh that's great. That's a really lovely way to describe, you know, that sort of joy,

 which we don't always hear, but to think that that's, that's encouraged you is, is just fantastic. I completely get, you know, where you're coming from on that. Did you find that there were any particular challenges for you? Because I know, I mean, you know, well, certainly in my era, which is, a lot further ago than when you started, it was so white male dominated, medical school, that I, I can imagine there might have been some challenges around that for you.

Karen Definitely, Ann. Yeah. It wasn't straightforward. I was somebody who actually applied for medical school three times. I did two degrees before I got to medical school. So I did a biochemistry degree, a bachelor’s, and then I did a master's degree. and every single time I'd apply before I did my bachelor's, I applied at the end of my bachelor's degree. and then I applied at the end of my master's. And finally at that time, and I had interviews every single time. So it wasn't that my qualifications weren't adequate. But when I had the interview, for whatever reason, I never got, given, an offer of a place at medical school. And in actual fact, I was the last person to get into the medical school I got to, which was essentially Charing Cross, which is part of Imperial College now. And I got in on the back of a waiting list. So I got an interview and I thought, well, maybe we'll give her a chance. We'll put it right at the end. And I was notified literally a week before the medical school started. 

So yeah, it was definitely a challenge. I didn't really see people like me in that medical school. I think we were less than naught point naught five percent if you look at the whole cohort of Black doctors. But what happened when I went into medical school is that in a sense, I had the imposter syndrome. Maybe I'm not meant to be here. I got here last on the list. And so I just, I worked my usual pace. And in the first year I won all, most of the prizes, um, at the end of the year for like academic prizes and clinical prizes and again, the same in the second year. So it then made me to, it's, you know, it brought home the fact that actually it wasn't a case that I didn't have the intelligence to be there at the point of entry. I was stopped probably because of how I looked. And that became a very real, you know, thing in my life to recognise that racism exists in medicine.

Ann Remmers I know that, you know, we'll talk a bit more about what you've done since you did that as obviously influenced, the road that you've taken in many ways, will have been influenced by, by that experience. I wonder what are the sort of standout moments for you in your career? Ah, that, you know, what are the highlights for you?

Karen It's for me, there have been several, but for the most thing that stands out for me is learning the power of listening. So, I think this is obviously something that we all learn in healthcare. sometimes we can come with our wonderful education. We've got our things in our minds. We are all affected by different biases that can occur from what we think a disease or illness is, and from the person in front of us, and also actually by sometimes from the people who've assessed the person in front before we've seen the person. 

But one woman that comes out to stand in my mind is a lady. When I was, I think at that time a very junior registrar. I'd probably been doing obstetrics for about three years at that time, who came into clinic and she wasn't breathing very well. So her diagnosis was that she had some sort of upper airways obstruction, and she looked really thin. She was a lady of South Asian origin and basically I could see in the story that she'd seen respiratory doctors before me. and the clinic was late. I just wanted to probably finish the clinic and get on. and I asked her, is everything so fine? She goes, oh yeah, I've seen other doctors and it's sorted. and then she got onto the couch, I examined her, she got off and the breathing got worse. And I said, look, actually, I don't think everything's fine. Can you tell me actually what has happened to you and what people have done? As I spoke to her, I realised some of the investigations that had been, issued by the obstetric doctors hadn't been completed by the respiratory doctors because they thought she was pregnant. So nobody had actually looked down in her airway, but it had been documented that she'd seen them and gone for the airway test. And so I called the respiratory doctors. 

And the long and short of it is that they decided after checking her oxygen SATs, she needed to be seen urgently. I had to persuade them that lady, if she hadn't gone on that day, probably would have died because she had an inflammatory condition which has caused her airway to become obstructed and they were able to resect it back. and so that taught me the power of listening and the power of not always assuming the person before you has documented fully what is happening in that patient's story. and it has driven, the rest of my practice from that day.

Ann Remmers That's so beautifully describes the power of listening to a patient and hearing their story. And I remember when I first met you, I, I heard you speaking at a conference And I was struck by the way that you described inequity and the impact of inequity on outcomes, but you linked it so beautifully to data and you gave a very powerful talk and that that left such an impression on me because, that's how, you know, I learn through the story and the visual, like a lot of people. And so, and data can sometimes be so hard and, you know, for people to understand, but you did it so beautifully. And so I wondered if you could just tell us a bit about what led you, I think I can see some of that coming throughin what you're telling us now that led you into looking at the impact of health inequality on outcomes through data?

Karen Yeah. Thank you. Ann. I would say I remember kind of a light bulb moment because we've got the wonderful MBRRACE reports that come out, haven't we? Every triennial and throughout my, career, these reports had come out, but a lot of the time they were reported as sort of women from Black and Brown communities having worse outcomes, but in the context of immigration, and, not speaking English as a first language. And that's how it was always layered or given to us. 

And I remember a, a report coming out probably, I think the one, the reports that came out maybe around 2019, 2018, that essentially it was very clear that when the analysis was done, if you looked at the data properly independent of social economic status, immigration status and language. Black and Brown mothers were having worse outcomes in maternity. 

Now, this was a real trigger to me because I had had my own personal story of, medical harm in my own family through people not quite understanding how to deal with my son. At the time, my son, um, had developed a chest infection. He was quite unwell, his dad took him, um, and he would go back home from A&E. I was at work, went and saw my son. I could see blue around his lips, took him back. Um, and my, I wanted to, to go with him at the time my husband took him before I could get there they had left and discharged him again. So I took him back a third time. and again we were discharged. 

And it's very difficult because as a Black woman, when you feel there's something wrong, if you persist, you're often perceived as aggressive. So I just basically went home, laid next to my son, and prayed that he didn't die because I could see his chest rising and that his lips were blue. And I thought, why are they not listening to me? Is it me? Maybe it's my own lack of knowledge. I'm not understanding. So the only thing that saved us was that the fact that he'd had a chest X-ray. And so, essentially the chest X-ray had been reported. But when you report chest X-ray, you don't see colour. And the chest X-ray had showed that he had only one lung left because the infection was so bad, he had pus from the bottom of one lung up to the top. And so they started calling around, where is this child? This child will die if they don't come straight back to hospital. And that's how he got his treatment. 

So it then called to mind, and I started to sort of think back to that time that it's because the caregivers at that time couldn't recognise the cyanosis in him, which was obvious to me. also, it calls to mind my own birth experience with that same son. I've got three children where I just didn't receive nice care, but also I actually didn't really expect to see receive nice care in a funny way. Uh, you know, I went in my water gone. I was actually breech. they didn't have space on the label, so they put me in the ward and then then they hadn't monitored me. So I just went gently to the desk and said, do you mind monitoring me? And she said, well, is your baby kicking? I said, yes, and she said, well then you know it's alive then, don't you? And that was all I got. Um, and my experience through That pregnancy was similar. I'd had um quite a disorder called graves disease where I had a really high, thyroid. and so my baby was small, I was very thin and I'd had to navigate that care in a way which wasn't optimal. So I ended up delivering that at term, but slightly early at thirty seven weeks. 

So when I saw those statistics, it kind of brought everything together for me. me. And I thought, oh my gosh. So I thought it was perhaps just me. We do hope that it's just me and that it's not other people that are experiencing that. but I very much recognise that if you look carefully at the data, extract the socio economic, um, immigration status and so forth, a woman who's Black with a good socio-economic status has a worse outcome than somebody who's white with a lower socio-economic status. And when we say status, I, you know, I don't really like that word, but we're talking about dispensable money to, in a sense, provide more health care for themselves. So then at that point, I thought, we need to do something, we need to speak up and, um, really pull the data together so people can see it's not just about, people not speaking English, and that's why they're dying because they're not coming into hospital because they don't know anything and they don't understand about the health people understand about their health are also dying and their babies are dying too.

Ann Remmers That's that sounds incredibly traumatic and scary for anybody and I can see how that would have impacted on, what you did next and how that actually really, really difficult in that situation to be able to come up with something that is positive. But clearly is something that that has, has driven you. And we, I guess the other thing that we're learning a bit more is, is also the impact of that stress as well, that we're, we're just starting to understand a bit more about that.

Karen And it's really interesting because obviously somebody just brought out a newspaper article recently and I was like, oh, we've been talking about this for seven years. And this is the concept of weathering. which initially was, highlighted by a lady called Geronimus in the US where she was taking care of um, predominantly women in Black communities in the US and couldn't quite work out why young Black women were having poor outcomes such as preeclampsia, gestational diabetes. You know, they looked like relatively normal weight and they shouldn't really be having these outcomes. 

So she started to look at some work, looking at some more some genetic changes on telomeres, chromosomes, which showed that they had accelerated metabolic aging and then looked at metabolic markers, such as cortisol levels. Hba1 C these are all markers of stress within the body and realized they were elevated in this community. And then when she factored and took out all the other, um, sort of confounding variables, it was associated with the fact that they were, Black and experiencing racism. And she coined the term weathering that being in an environment. Imagine you're, we're all wonderful trees in the forest and some of us, are shielded by others by the fence. But some of us are out there in the open, being really weathered and battered by the storms of life. And that's essentially what weathering is for Black and Brown communities. So it's advanced metabolic aging, which occurs. And therefore it also contributes to poorer outcomes. And it was interesting to see that recent article where they also talked about it and highlighted it in the news.

Ann Remmers Why do you think, um, this is a really difficult question and I, so I, yeah, I just throw it out there, but why do you think disparities have existed for so long?

Karen we've talked about the, my sort of history and also the historical evolution of the embryos data. I think it's because we don't necessarily report on it in the correct way. So people don't understand the depth of the impact on it. You know, obviously racism is at different levels. It's interpersonal racism. There's structural racism, there's systemic racism. and people don't know how to split the three. So oftentimes when you mention the word racism, it gets people's backs up and they feel like, well, I'm, I'm a nice person. I can't possibly be racist. but there are simple, stereotypes and things that happen that input ideas and perceptions into our minds, even without being conscious about it, that would lead to racism. And people of all colours can be racist as well. So you can have Black on Black racism. It can have white and white Racism. Black to white. White to Black. You know, Brown to Black. It's a whole, recognition that we are a human race who were brought up in different ways that causes our mind to see things in different ways. 

So therefore it means, I must say, I think sometimes we don't report the data correctly. So therefore people interpret it. So for example, I've had this recent argument with ChatGPT because I was doing some research, around maternal inequities. And The first thing that came up as a reason was missed appointments. I was like, but why are you putting missed appointments when actually that's the lowest proportion of what you can attribute to it? And then ChatGPT then came back and said, oh, actually, Karen, you're correct, it is the lowest, but I've reported it that way because all the researchers report it that way in their papers. And I said, well, that's a bias. And he goes, you are absolutely correct, Karen. That is a bias. that makes people think that it's about missed appointments and people who don't speak English. and perhaps the better way to report it, ChatGPT is talking about delayed escalation and said, yes, you are actually correct. 

So what happens is that when we get used to reporting something in a particular way, it continues to make us feel comfortable that the reason why people are getting these poorer outcomes are It's the Black and Brown bodies that are broken and it's their issue not recognizing actually, it's the system in which we're taking care of them, which isn't fit to take care of them so we can adjust that system. 

So, you know, the work that we've done on the NHS Race Observatory, quite clearly demonstrated how we were able, within the space of three months at Imperial, to make haemorrhage rates equitable between Black, Brown and white women. But the reason was that is because we challenged our system. We recognised that simple things such as recognizing pallor when skin is pale, You can't in Black women. So therefore we've got to have another way to look at it and act quickly. So because we don't always recognise it. But in a woman, that's why I can go into a room and say, oh, she looks really pale. Check under the sheets. There's blood there. Quickly, guys, let's do all the stuff and get things ready. Get her blood sorted. The Black woman, you won't see it. So therefore they can add on an extra five minutes. An extra five minutes can mean an extra litre or two litre of blood loss. But if we put other steps in place, which is what we did to make sure that people can act quickly, it makes a difference. And then the care is equitable. 

And that's when we talk about a system being racist. We're not saying somebody set it up to be racist and cause harm to Black people. But actually, now the way in which we operate in that system, because it's not looking at the people of all colours and what they require, it means it's not providing effective care.

Ann Remmers I just, um, thinking a little bit about how I, when I met you and then I asked you if you would, out of the blue, this strange woman came up to you and said, would you come and talk at our Black Maternity Matters celebration, which I think is probably about four years ago now. I just wondered what your thoughts about, you know, the impact that something like Black maternity matters could makeand is making.

Karen I was so privileged that you asked me, uh, to speak. And I think you're one of the few organisations I've seen that's been so impactful across the landscape of maternity and being bold, even to have a, a title Black Maternity Matters, um, really is a standout, organisation. But not only in that, it's how you have managed to really allow people to grow, because understanding racism and differences is a growth of us as a human race. We are all the same race, um, and understanding, um, how you can enjoy life better. and often what we do as people in all terms of our personal growth is the things that are uncomfortable. We suppress them, we don't take them out and fold them, look at them, deal with them. And that can be how we interact with other people, how we interact in our relationships, how we interact with ourselves. Those things become suppressed and therefore the opportunity for us to grow and become a better people, enjoy the world and a better way is lost. That opportunity is gone. 

But what I feel that the Black Maternity Matters programme does, it really challenges that. And I could see when I came to celebration, people who were so grateful for having gone through that and had had the chance to really reflect on themselves where they work, the impact of history within the UK and globally. And they had really you could see in their eyes, in their soul, in their spirit, in their words, the true transformation that they brought to the system and the true change in themselves. And what I loved about the programme is the way that people came together. 

You know, my real love of the world is the love of people. I am somebody who has a very diverse, friends and family base. I, you know, have friends from South Asia, East Asia, um, from England, from New Zealand who are white, Black, Brown. And I think it's really enhanced my life. It's the same within my workspace. I think I'm really privileged to work in a space where most of my colleagues are very diverse from background, and I think it's made us, uh, see things which perhaps not are always seen because there's great diversity of thought. And I've seen that in Black Maternity Matters. And I think that's why you've been so impactful as well.

Ann Remmers Well, we're very grateful that that you've continued to support us. What do you think makes the biggest difference though in improvement work being successful?

Karen, I think the ingredients for success in every single improvement work is to hold everybody together across the whole system. So not to think, you know, sometimes people do improvement work. They want to hold it to their chest because they want to be recognised for it. So, it's not about necessarily being recognised. It's about actually everybody being recognised. So for me, the important people that I speak to were the midwives, the nurses, the anaesthetists, the obstetricians, the junior obstetricians, everybody that's involved in, in delivering the care of the women across the whole system and not thinking, I just know what I want to do, I want to hear the, the ideas from everybody in our work, we partner with another hospital in London, again, recognising just because we work in London, we haven't got the same practices or the same communities. What are you seeing there that we can learn from? So, speaking to lots of people. 

And then when you've got that, you then, you know, we know if you're looking at, um, Scientific American had a paper where they basically looked at what had the most impact. They're the people with the most diverse authors that have the most impact. If you're looking at FTSE one hundred companies who do the best, they're the ones with the most diversity within their workforce. So, it's really important to get diversity of thought in any implementation or innovation program that you have. 

And then the other key ingredient I would say is to spread it wide. So, to spread it, you know, within anybody within your own sphere, but to give it to other people to spread within their own sphere. so, I love LinkedIn as a resource and, you know, just posting it on there. And we've been to Australia to talk about the haemorrhage work being contacted by people, in other countries about the work that we've been doing. 

But also, for me, it's recognising people who were along with us on that journey. So, for example, Black Maternity Matters, the NHS Race Observatory. So, we're really pleased to have had that health equity conference, which has really fertilised that landscape even more. So, lots of relationships were made at that event, and people are doing really good work with lots of organisations because of it.

Ann Remmers Yeah, all of that is making such a difference. And can you tell me how you maintain your hope and positivity because you're so busy?

Karen I love you Ann!

Ann Remmers There must be times when you are very tired!

Karen, I know. I think there's obviously that initial rejection early in my career made me realize that sometimes people, people reject you because they don't see the value in you. And it doesn't mean they're correct. They're just not your people. And for me, I've always sought out, who are my people? The people that I connect with, that nurture me and give me strength. It's not going to be everybody. And that's okay. We're all different and we're all different for a reason. But that connection with the people who are your people makes a huge, huge difference. I'm also somebody with great gratitude. I recognise that I'm just a little girl who was born in Isleworth who could not have, you know, maybe have had the opportunity. I see it as real opportunity to change and to touch lives. I'm grateful every day in that, knowing that it makes such a difference. 

I'm very grateful to my patients. Um, they are great people who, who pour back into me, you know, as I can see next to where I'm sitting now, a picture frame that I got from a patient who I, I came into her room on the labour ward and, you know, it wasn't going well. And I just said to her, you know, let's be positive things will go well. And she had a lovely, beautiful delivery. So, she's given me a scripture from Joshua one, be strong and be courageous. Do not be afraid, Karen. God is with you. And I feel that gives my patients. Give so much to me. You give to others; they give back to you. Um, you know, I have a deep sort of spiritual belief as well, which gives me lots of positivity, but in it, I just choose every day not to look at the things that have not gone well, but to look at the things that have gone well, and also what is within my gift to make an impact and to make a difference. And that is what continually drives me. Seeing the change and seeing the positivity in other people's lives.

Ann Remmers That's a great outlook, I think. one with that such positivity. and I can see how that embodies in, in the work that, that you're doing. I just wondered what advice you'd give to someone say the young Karen Jo ash or somebody that's not sure. Somebody who's not sure at this moment in time what they want to do. What, what advice would you give to somebody about setting out in their medical career who at this point they don't have the power to influence?

Karen Yeah. So, I would say to people, one really core thing is not to focus on things that you see as weaknesses, focus on your strengths. Because when I look back, one of the strengths I had was actually talking to people and listening, but it wasn't necessarily highlighted. I was thinking it would be about academic papers or to get this and get done. But in the listening and really connecting with people is where the real deep learning was. Learning about medicine, learning about what people really care about, what touches them, and then learning to listen to patients.  I learned to listen to doctors, learn to listen to stories and learn to listen to the whole team. So, you can bring together, um, a team that works well when you lead a team. 

And then to really, recognise that in yourself, even if you feel you're not recognised for something, because there were many days where I wasn't recognised for something. I really did find that; I had a really good friend. Her name is Briony. I'll mention her. And she just said to me, you know, even if you've got an idea and somebody takes it and runs with it, don't worry Karen, as long as that idea is seeded into the system and then grows and becomes a change for other people for their benefit, um, that's the ultimate gain. So, for me, even if I'm not recognised, it's not about awards or anything. I, you know, I'd love to talk to people. I will freely give my ideas because I know that it will change lives for the better.

Ann Remmers Thank you. I wonder what's next for you. What are your priorities next?

Karen So still very much involved in the health equity landscape. But what I've recognised, and I've always been challenged with, you know, I, I'm a quite passionate believer about, health equity can be changed. and one area I've been looking at is a gender health gap. I recently had my own health challenges, and I could see quite clearly how, because I was a woman, that some of the care that I was supposed to receive in an emergency setting I didn't receive. So, the next thing for me is really, focusing a lot on that. 

As you know, I also have, looked into the world of functional medicine. So, I love looking at how does the body repair itself. And so, we are in the process of writing a book called the Black Women's Health Bible with one of my really close colleagues, Doctor Christina. and I'm really excited because we know that there's been a lot of negative talk in this space and we really want to bring solutions to the table that people can action for their own personal use, um, as well as their own system change as well. And that will, give a view on the gender health gap as well as the health gap for Black health in women as well. So really excited about that project.

Ann Remmers And that's a book coming out next year, did you say?

Karen Out next year maybe, probably not towards the end of this year, but the next year. Really excited about it.

Ann Remmers We will look out for that. I wondered if there's anything else that you'd like to leave our listeners with. Maybe there's a question that you want them to go away and think about?

Karen So I challenge you to think if there were more diversity in your life, how would it enhance you? How would it grow you? How would it give you greater peace as well? Greater impact, greater joy. 

And the book, I would encourage you to go away and read that really challenged me. and gave me lots of great ideas is Rebel Ideas by Matthew Syed, a wonderful book that really quite clearly described the power of diversity and, the fact that we are all given to each other as a gift. That's my strong belief. That's why we travel. We love travel. I love seeing new things. In that book, it clearly described, you know, some really sad events that have occurred in the history of humanity that could have been averted, perhaps if the people who were to safeguard some of those systems had diversity. So they were able to recognise and, and act on the danger that was ahead. 

So I would say to you, buy that book, have a look at it, um, use it in your own journey and think about how it can make you think slightly differently. So that you can innovate, impact and make change in the space that you occupy.

Ann Remmers That sounds a great recommendation. Definitely one to put on my book list as well. So, thank you very much for that. Karen, it's been great talking to you this afternoon, listening to you. Thank you so much for sharing your story, your experience, your advice, and your wonderful positivity which radiates from you. Is there anything else you want to add before we close?

Karen I mean, obviously, you know, if you want to know when the book's coming out, just follow me on LinkedIn or Instagram at Karen Joash, and if you want to know more about, sort of taking care of your health, we also run health clinics to support you if you want any coaching. We also help with that as well. 

Oh, one last thing I must add Ann, as you know, I'm also the research chair with Tommy's charity. I strongly believe in them as a really good resource. They really supported the Black maternity space and I've got lots of good resources and I'm hoping to work with them soon on some projects around, um, transforming maternity culture as well. So, watch this space for that's my probably my next health equity project.

Ann Remmers Thank you very much, Karen, and thank you for joining us today on Black Maternity Natters.

Karen Thank you!