Ep. 6 | Dr. Joseph C. Kolars - Leading Global Health Partnerships

In this episode of Voices from the Field, we speak with Dr. Joseph C. Kolars, a practicing gastroenterologist, medical educator, and global health leader at the University of Michigan. He serves as Director of Strategic Development for Global Collaboration at the University of Michigan Medical School and is the former Leslie D. Yamada and Tachi Yamada M.D. Director of the U-M Center for Global Health Equity.

Dr. Kolars joins Neil Nakkash to discuss his journey into global health and the lessons he has learned from more than four decades of building health professions education programs and international academic partnerships. He reflects on his experience helping establish one of China's first Western-style healthcare systems, the importance of creating sustainable and equitable global collaborations, and how strengthening education and health systems can improve healthcare worldwide. He also shares his perspectives on physician leadership, medical education, and what continues to inspire him after a career spanning clinical medicine, education, and global health.

This episode offers valuable insights for students interested in global health, medical education, healthcare leadership, and international collaboration.

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See you next time on Voices From the Field.

Transcript

SPEAKER_00 0:07

Welcome to Voice from the Field, the NAMA NextGen Podcast. I'm your host, Neil Nikosh. The way health systems and professionals collaborate plays a critical role in improving healthcare across the globe. In this episode, I speak with Dr. Joseph Kalars about his journey into global health, what it takes to create sustainable international partnerships, and how the next generation of physicians can be better prepared to engage in global health work. Dr. Kalars is the Director of Strategic Development for Global Collaboration at the University of Michigan Medical School and co-director of the Peking University and University of Michigan Joint Institute for Translational and Clinical Research. A practicing gastroenterologist, he previously served as Senior Associate Dean for Education at the University of Michigan Medical School, where he oversaw medical education across all levels for more than a decade. He is also the founding director of the University of Michigan Center for Global Health Equity. For decades, Dr. Kalars has worked to strengthen health professions, education, and healthcare systems through long-term partnerships with a focus on building equitable collaborations and preparing the next generation of healthcare leaders. We're incredibly honored to have one of the nation's leading voices in global health with us today. So without further ado, here's my conversation with Dr. Kalars. Thank you so much for joining us, Dr. Kalars.

SPEAKER_01 1:28

Yeah, it's really uh a pleasure to be with you uh uh today, Neil.

SPEAKER_00 1:33

So I first really just wanted to really discuss your journey towards global health work. You're of course a practicing GI doctor, you know, you trained here in the Midwest, and this is not necessarily the background people might immediately associate with global health uh leadership. Um so what was it that drew you toward global health work? And you know, how did your journey evolve from clinical medicine into larger things like health and education systems?

SPEAKER_01 1:55

Sure. Well, um, Neil, um uh as you can tell by looking at me, I'm more uh late career. Uh but um I can't say I really plotted or charted out I'm in the best place I could ever imagine, but I couldn't see this destination from where I was as a student. To directly answer your question, um, it was during medical school, I always had this interest in um in the world, uh international settings. And I happened to structure a uh international rotation of foreign experience. I saved up all my electives uh to the end of my uh uh senior year, ended up going to India uh and Nepal. In India, I was uh had a chance to work with Mother Teresa for a bit, um, but I was largely in a hospital in uh Bihar, India, and uh and then had a chance to work in a hospital in western Nepal. Uh and these were incredibly rich but disruptive experiences. Um I thought I was just going kind of as for for tourism and a chance to maybe see what another healthcare ecosystem looks like. But um where I became really disrupted is it challenged my assumptions. Um I could suddenly um see different aspects of healthcare, different aspects of needs, uh, how people's context and culture influenced what they were looking for. And I could also see our own healthcare system from a foreign land and started to question why are things this way back in the US? And how can we learn from other systems, other cultures? So uh I felt like this was the most transformative aspect of my uh student experience uh in medical school. And I said, gosh, I wish I uh everyone could have this. If I could make a rule, everyone would have to get out of their own culture, their own system. So that's where I got the bug, so to speak, for global health and global experiences. Um and um, you know, at my core, I'm a medical educator. I happen to differentiate into gastroneurology. Uh, and when I'm in this culture, when I'm at University of Michigan, um, that's my clinical identity as a gastroneurologist. When I'm in the global sector, um, I'm not doing gastroneurology anything more than general medicine and general care, public health, population health. But my common denominator has always been medical education.

SPEAKER_00 4:36

Most definitely. And I think you brought up a really good point about when you went to India and Nepal, you mentioned that sure at first you might have gone for tourism. Um, but you know, it it showed you the ways other health systems have something to offer towards us, towards us in the US. And part of your work in global health has really been focused on sort of um sustainable development, mutual development um with global partners. Um, how did this experience really inform that? And how do you try to do that in your uh day-to-day work?

SPEAKER_01 5:06

Sure. Um, one of the aspects that that was really imprinted on me from my early global health experiences is what a difference uh a system or a context makes in terms of health and healthcare. Um you know, I I really resonate to this, to this truth, to this piece of knowledge. Uh, and that has to do with the question: what what determines a person's health? You know, what um uh you know, and sometimes we don't ask that question enough. But when you look at that from the research or scientific viewpoint, uh about 50% of a person's health is determined by their genetics. About 40% is the social determinants of health, the situation into which they were born, their education, the what's their family's uh economic and social status, uh things like that. So that's a huge piece, social determinants. But only 10% of our health is determined by health care. But at least in the United States, that's where most of our money goes, is into health care. And uh and it's it's really put our economies often into a tough place. So um more attention needs to be placed on those social determinants and how to keep people healthy or prevent illnesses rather than all the money we spend at the end of it. So um one of my hopes in in the global health environment is to help other systems uh wrestle with that. I think the worst thing that can happen is if people start to duplicate every aspect of our healthcare system here in the U.S., I worry about that. Uh, because we have a number of good things here, but we have a number of things that are not so good and not sustainable. So hopefully these other evolving cultures um will leapfrog over us and come up with something uh new uh and better. One of the other um aspects of your question um prompts me to talk about um one of the other things I I observed early on is just the art and science of collaboration. Um global health uh was founded on kind of a colonial principle. Uh uh how can we keep our soldiers healthy when they go into foreign lands? How can we make our businesses prosper when they go into foreign lands, often with uh lower uh income levels than us, but it could be really seen as colonial and extractive as it as opposed to how can we go in and truly meet people where they're at, collaborate, co-create, co-design, uh so that we're not coming in and just laying on our agendas. So one of the things I learned very early on just by observing is to see how local uh uh uh uh groups would respond to people like me coming in and um who are are getting into really synergistic collaborative relationships as opposed to who are kind of into these transactional relationships. Will you help me get a grant or or or or do something that's gonna advance my career? So those were some pretty powerful lessons that I I learned later early on.

SPEAKER_00 8:33

I think we're gonna really get into a lot of these lessons and themes that you're speaking on, especially the sort of um inherently colonial aspect that might come to global doing global work. Um, but first, before we even get into that, I wanted to ask about your experience in Shanghai. So you spent uh a period in the 1990s helping develop one of China's first Western-based um Western-based health systems. Can you speak a little bit about that experience and which lessons you tried to take from US healthcare, other systems, um, and trying to bring them into that new context?

SPEAKER_01 9:05

Yeah, uh that was an interesting part of my journey um uh creating a new healthcare system in China, specifically in Shanghai, where I moved with my family. And uh it was it was a curious opportunity. They they gave me the first less license they had ever given a non-Chinese physician. And um one of the goals they had is that they wanted uh a Western healthcare system um to help support their burgeoning international community. Um as you point out, this was the 90s. Shanghai was becoming more and more the economic engine for China, having more and more of an international community. But people were hesitant to move there or to move their families there because they they really didn't have the kind of health care infrastructure that they were familiar with uh in the US or other Western health systems. Uh, China's system uh was still evolving, uh, a lot of traditional Chinese medicine, a lot of Russian-based uh systems, but it just wasn't familiar or comfortable. So one of the big goals of uh the the government, the school where I was working there, was to provide a system that can take care of the international community. Um what ended up being an enormous surprise to everybody was that Chinese people wanted to come to this. Um uh you know, we expected them not to come, that this is foreign, this is not part of their culture, it's much more expensive than uh than the local situation. But what was attracting them was just a different aspect of what they perceived to be quality. Um also there's this otherness factor. Sometimes when people are a little restless with what they have or uh what they have isn't working, uh they look to something other. Um I see that a lot in our culture here in the United States. There's a lot of attraction towards traditional Chinese medicine. There's an otherness there, and there's also some really good aspects and positive attributes. And for a lot of people there, wow, they were really attracted towards this otherness of Western medicine. So to your point, to your question, Neil, um, what were some of the lessons learned? Uh, one of the things I really had to learn is uh to understand better what people were looking for. Um, in our culture, we kind of have a sense of what people's expectations are, and that's why they they came to this particular moment or this particular person. But I had to spend a lot more time unpacking what people's needs and what was driving them to actually seek out this particular care and uh to really understand where they were coming from. Um and that was a really powerful lesson. Another powerful lesson was spending a lot of time trying to understand how I was perceived by others. Um, you know, here I am an outsider uh coming in and practicing medicine. Suddenly I've got a medical license. And how are the other doctors and the healthcare workers and the leadership, how are they perceiving that? So I had to spend a lot of time understanding how I was being seen and how I was being understood so that I could form effective collaborative relationships and leverage up from there. Um, I got really in touch with how often I operate under assumptions. And I don't necessarily check those assumptions with how patients, colleagues, other providers there were seeing me. So some pretty powerful uh take-home messages for me.

SPEAKER_00 12:58

I can only imagine, because I think when you're discussing these assumptions, it could come from both places. Um, oftentimes, people in people in the countries that you may be doing work in having an assumption about you that's rooted in sort of the history of global collaboration. How have you gone about addressing that? Um, you know, addressing those assumptions and ensuring that the global collaborations that you engage in are something that um are specifically longstanding, mutually beneficial, um, and you know, really don't veer into that uh sort of one-sidedness that we sometimes hear about, where it's like sort of the higher or um more more economically uh adept nation coming to help the lower or middle income country. Good question.

SPEAKER_01 13:41

Um two components of my approach really leap to mind. Um is um uh I really try to emphasize appreciative inquiry when I'm starting off in a new situation, a new collaboration. All too often people like us come into settings and they think they know what is needed and what is required. They have something good that they've been doing that they want to do here. But I really try and spend most of my time initially asking questions and trying to understand the local situation and where people are at. Um and um and really try and and again look and see how they're looking at me as well. Often I'm in low-income countries, low-income settings. And it's hard to get at what people are looking for when they're looking to people like me as being a source of money and resources. And you know, as much as we try and say, Well, what do you want to do? What's important to you? The back of their mind they're going, you've got the money. What is it that you want to spend it on? So it's it's it's it's this dynamic that needs some work. But um bringing appreciative inquiry to that dynamic, bringing humility to that dynamic has been really um important to me. A second um component of the approach that is really important to me is first um working on creating a relationship. So many times people in uh the US, my culture here, they're a very transactional people. And they'll go in to a global situation and it can be transactional. Well, there's this grant opportunity. Um, I see this problem, I I've got an idea to to solve, but they want to get at what it is um we're gonna do. Very transactional. Most of the world, or at least low-income parts of the world, they first value a relationship. And I learned this in China, but don't first come in figuring out what you're gonna do together. Try and figure out how you're gonna be together and see if you have common values. See if you like each other, see if if you're motivated by that relationship to do something. So first craft the the relationship and then it let it evolve into doing something. Um again, I see one of the common uh American approaches from our culture and what's played out in global health is people will uh they'll come in and say, well, let's do this, uh, let's let's let's plan our study, let's plan our intervention. And in the back of their mind, they go, Yeah, I hope we get along. I hope we have a relationship, but um, but it's not as important as the doing. And this this feeds into you know the essence of your question. How do you how do you make things sustainable? How do you build for the future? And again, that depends on, well, you're building relationships. You don't think of of of friendships as defined contracts. Um, but there's so much at global health where the relationship has only existed because of a certain grant or something like that. But one of my approaches has been trying to emphasize our relationship and the kinds of things we could do together and create or even just be supportive from a distance to each other.

SPEAKER_00 17:38

I've I really hear these insights and I've seen them be put in practice at those events organized by the Center for Global Health Equity. Um, so I really commend you on that because um I believe it was Dr. Moyer, where she hosted a session at the Center, a Center for Global Health Equity at the Rackham, um, must have been early January of this year. And I remember just like taking her insights where she really discussed um thinking about global health as relationship building, really having that focus on it, because it just changed the way that I wanted to you know work with um the global partners that you know I've come to know. Um so on that point of the work that's done by the Center for Global Health Equity, you are of course uh the former founding executive director. Um when you went into establishing that center, what was, I guess, a gap that you saw in global health work done by academic institutions that you really wanted to address? And I guess I really see that equity piece. A lot of places might just be called the Center for Global Health, but you really put equity front and center. So really just wanted to ask um about your motivations with that as well. Sure.

SPEAKER_01 18:40

Um, probably the the biggest motivation was the opportunity to bring different thinking or different disciplines to global health problems. Um in academic institutions in the global and in the global environment, often people are competing with each other. And uh and you know, uh grant opportunities or or partnership opportunities, um, you know, they want to get into the best position possible. But uh, and then what that ends up is that you can find a lot of global health approaches that can be dominated by a discipline. Oh, this is mainly about public health people, or this is mainly about doctors, or this is mainly about nurses. But there haven't been a lot of drivers or incentives for people to play across boundaries and to say, you know, how can different disciplines and different ways of thinking really be applied to a to a problem? So one of the big drivers for the Center for Global Health Equity is, you know, we're we're a public university, we're a great public university, we have all these schools and disciplines. You know, we have about 8,500 faculty. But um, because of academic incentives, often people stay within their lane and they're just doing things on their particular branch of the tree. And there aren't a lot of sense of incentives or opportunities to get completely outside your discipline and learn from somebody else. So um, so the the foundation for the center and one of the the big things that we we do is how can we bring people together from across campus that people aren't used to working with or thinking with to come up with solutions? And uh again, I go back to that earlier figure, you know, only 10% of your health is determined by health care. But we've got all these other people working on the social determinants and other things. So when we take a project, rather than just having maybe uh a doctor and a nurse, and uh, but wow, what would happen if we brought an anthropologist into the discussion? What about bringing somebody from the business school to think, well, is there an entrepreneurial opportunity to help people make money here? What about um, you know, engineers are problem solvers. What if what if we brought engineers into this picture? So um, so one of the the the things our center does um is it gives grants. You can't get a grant unless you've got three different schools or three different disciplines involved, because we want that different co-creation of people. So members of our center come from across the campus. This is not just a Michigan medicine show, um but we've got you know our school of environment and sustainability, our our school of social work, um information, the people from LSAA. So, and it's it's been Fun to watch because a lot of times these people are not used to working with each other. But suddenly, when there's a problem, there's an opportunity to do something impactful in uh in a in a low uh middle income setting. It brings people together in creative ways. So that was one of the really new aspects. At the time, there were no other centers of global health equity. Uh, that's now a really common term out there. And I can't say there were other centers that we saw around the United States that were really playing to their whole orchestra of people across campus, but that's been a real uh crucial aspect of our success.

SPEAKER_00 22:43

I think it's very impressive to see. I think about all the CGHE uh events that I go to, I've met, as you said, people in environmental science like Dr. Vidal Bhat, um, you know, social scientists like Dr. Moyer, all sorts of physicians in different specialties. And I really do like that emphasis on multidisciplinary work, interdisciplinary work, because again, no single specialty has the answers for these very real and large problems. Um, so I think this is a great direction um, you know, for other centers to take as well. Point of physicians sort of sticking to one lane. You know, oftentimes um people's career paths uh or physicians' career paths, some might only stay as clinicians, some might, you know, focus more on academics as researchers, but you've had a very broad career across research, uh clinical care, global health work, of course, administration, education. You know, what was it that really led you to really want to have all these different dimensions of medicine involved in your career?

SPEAKER_01 23:41

Sure. Um I I I guess I I I would have to say uh uh Neil that it was just the the attractions of the moment. Um, as physicians, we're we're extremely privileged people. Um probably uh it's an outsized privilege uh that we have to be very careful of. You know, we're we're highly regarded by society, uh, you know, the salaries are good, the prestige is is really high. Um, and the foundations of our preparation are dealing with the people that's in front of us. So um it's it's that hospital care, it's that clinical care, but again, it's only 10% of the equation. And um, a couple things that drew me out of just that dynamic. Um, I still do a lot of patient care, but what drew me out of that dynamic was just looking to see um all the other aspects of the system that kind of can influence a person's care. And I had this restlessness of um, you know, wanting to make things better. I think it's common across so many humans. They they want to make things better. And um and you know, doctors are drawn in because they want to make patients better. Um, but then there's a generalizable aspect there where, well, I want to make systems better. And um and doctors go through a long period of training. I had a real restlessness that I wanted to make education better. I found it so highly variable. When I had a when I had a a great teacher or a phenomenal learning environment, wow, it was a thing of beauty. It was just so energizing, it was so addictive. But I have to say, most of my education wasn't that way. Uh, you know, I spent a lot of time with with uh so-so teachers or so-so learning environments. But what was presented, what was clear to me is that it could be different when you see examples of things that are just so dynamic and so creative. I wanted to increase that ratio. And that's where I think my making things better ended up pulling me. Um, and um, and it was more, I can't say uh I could have never predicted I would be talking like this when I was a student, but things kind of evolved in front of me. And um one of the things I see a lot of students wrestling with right now is trying to be very deterministic in terms of their careers. What is it exactly they want to do? Um boy, I was never that way. In fact, I would encourage people not to be that way, but to more take advantage of the things that pop up in front of you. Um most of my opportunities were questions I couldn't see coming. I could have never seen the invitation to go to China or the invitation to work at gates or things like that. I could have never predicted that those were coming. I wasn't gunning for those, I wasn't applying for those. I suddenly popped up. So, how can you design things and be in a place where things pop up, where opportunities come onto your radar screen, and for you to say, well, you know, that sounds different. It doesn't sound necessarily linear with my path, but I'll do it. So um, so that's that's how I've kind of thought, and it's broadened beyond um maybe what I would call a traditional clinician pathway.

unknown 27:35

Yeah.

SPEAKER_00 27:36

One of our earlier guests said something similar. They said, you know, it's it's it's hard to it's hard to imagine that I would be at this moment doing all the things that I had done. You and it goes to show how it really is difficult to plan so neatly for a career path. Things sort of just happened. So I really like that piece of advice for audience members. Um, finally, for our last question, I always ask our guests, what are some book or media recommendations that you would recommend for audience? What are like in particular books that you have found change your ways of thinking um that you think that we would really benefit from looking into?

SPEAKER_01 28:11

Um Wow, I have to I have to be uh reflective here um and maybe uh end up citing some some some authors. Um I I wish I was better at remembering specific names and specific books. But um but there are uh a couple of ones that are kind of old standbys for me. And they're they're they're a bit old, but I still think they're good and they're relevant. Um one is uh the book Good to Great, which was uh really pop popular in business circles. But it's it's for systems um uh uh thinkers, it's uh it's it's a it's a book on how do you try and organize and move systems from a from a good to a great uh uh threshold. And um and I always um uh found that uh to be a really helpful book. Uh The Innovator's Dilemma, uh uh which is out of um the Harvard uh business school. Because again, for people who are trying to work on solutions, um working on creativity in no matter what field, um how do you actually take that? You know, we're we're all kind of structured to work within the system. But how do you actually bring the creativity to making the system better or making the system different? Uh another book that really changed my my way of thinking is by uh the the New York Times author Tom Friedman, called The World is Flat. And um, again, a little bit of an older book, but um, you know, for so long, so many people have really been compartmentalized, and um, you know, their geographical focus has been dominant, and they haven't been able to think beyond those boundaries and those confines. And I found that book to be uh uh uh particularly helpful and and good. So those are a few that come to mind, uh Neil.

SPEAKER_00 30:34

Yeah, I think those books themselves, those recommendations I gave, really do show the interdisciplinary way that you've approached your work and you know the multidisciplinary thinking that you yourself have. Well, thank you so, so much for joining us. I found this in the conversation incredibly thoughtful and insightful. And I think a lot of our audience members who are interested in global health work will really benefit from hearing um about your experiences and the lessons you've learned um from those decades engaged in global collaboration. So, once again, thank you so much.

SPEAKER_01 31:02

Well, thank you for hosting this, uh Neil. And as as I think you know, I'm a huge fan of Nama NextGen. So really applaud and appreciate your good work. So uh good talking with you.

SPEAKER_00 31:14

Great talking with you. We really appreciate your praise. Sure. Thank you. Thanks for listening to Voices from the Field, the Nama Next Gen Podcast. If you enjoyed this episode, please make sure to follow us on Instagram, Spotify, Apple Podcasts, and YouTube to stay updated on our upcoming episodes. We'll catch you next time on Voices from the Field.