President's Podcast: Fostering the next generation of Hispanic leaders

Carlos del Rio: [00:00:10] I am Carlos del Rio, president of IDSA. Welcome to the Let's Talk ID podcast. Joining me today are three of my fellow board members who, like me, are Hispanic ID physicians and foreign medical graduates. Dr. Lilian Abbo from Venezuela and now at the University of Miami, Dr. Cesar Arias from Colombia and now at Methodist Hospital in Houston, and Dr. Max Brito from the Dominican Republic, now at University of Chicago, Illinois. They are all here with me to have a conversation about Hispanic leadership in infectious disease. Buenos dias, doctores.

Cesar Arias: [00:00:42] Buenos dias.

Max Brito: [00:00:43] Buenos dias, buenos dias.

Carlos del Rio: [00:00:44] Let's start by having each of you tell us about your journey from your nation of birth to your successful careers in the United States. Why don't we start with Lilian? Do you want to.

Lilian Abbo: [00:00:52] You want to know why I chose ID and how did I relocate from Venezuela to the US? So I was born in the US. My dad is a doctor. He was doing his residency training in Penn and my mom got married in the middle of studying economics and my grandparents told her that you never know if you're going to be married for the rest of your life. And as a woman, you must finish your career. As my dad was getting admitted to Penn, his chairman had to call the dean of the business school in Wharton and said, I have the wife of Dr. Abbo here. She needs to finish economics. So my mom got into Wharton and had to finish economics there while she was still studying economics in Venezuela. So I was born in the middle of all of this and three months later, we moved back to Venezuela. Was only three months old. I grew up in a family where women and men went to school and it was expected. Education was always highly valued in my family. When I decided to go into medical school, it was very late into high school. Remember, we don't have college in Latin America. We just go straight from high school. So I was 16 years old when I graduated high school and I decided at that time that I wanted to be a doctor. And my dad actually was discouraging me. He really wanted me to be a lawyer or do something where you can really earn more money or have a more flexible life.

Lilian Abbo: [00:02:00] But I was stubborn. I said, Let me try medical school and if I don't like it, I can always go and study jewelry design or something fancier. I got into medical school and my first year was pretty painful.  It was hard. You come from being a great high school student and you're getting to the reality that you're just one more. And in Venezuela, you have two choices, when you're a woman, you can be Miss Venezuela. I didn't have the looks or the height to be Miss Venezuela, so I decided that I wanted to be smart and I wanted to be a doctor. I met amazing people during medical school. We trained in a country where we have health disparities all along, where you have private hospitals that have state of the art technology and you have the public institutions where you have gauze some days and some days you don't have gauze and you have to pay out of your pocket to get nebulizers for your patients. And you have to treat everyone equally. So equity and treating everyone the same was very early in my career a priority. And it was the 90s. So we had the first cases of HIV and my dream was to find the cure for HIV. But very early in my career, I also knew that I wanted to come and train in the US. So right after med school, I met my husband and I decided that I was coming here to do my residency training.

Lilian Abbo: [00:03:08] And then my plan was to go back and give back to my country. But Hugo Chavez had different plans. My country became communist and we have never been able to go back.  I was very fortunate to have amazing mentors here when I first came. You come as an FMG. You don't know anybody. You think your letters of recommendation from Latin America are amazing. Nobody knows who you are. Nobody knows these doctors. So you have to start from scratch. So I have to work as an observer in HIV for one year for free. You know, I always say as an FMG, you always have to work extra hard and demonstrate who you are. Once I started my residency in internal medicine, I knew I wanted to do HIV. But then what happened is, as I got into my fellowship, I fell in love with transplantation. It was like HIV on steroids. That's where I am right now. I ended up in Miami. I am very fortunate to work in a place where I can give back to the community. We have a very large Hispanic population. The good thing about Miami is that it's close to the United States. So our first language is Spanish, and my patients are people like us, people from different backgrounds. And one of the things that we do at Jackson in the public hospital is we provide care for everyone equally, regardless of their ability to pay.

Carlos del Rio: [00:04:15] That's great. Cesar, how about you?

Cesar Arias: [00:04:17] Yeah, my experience a little bit different. I was born a bit earlier than Dr. Abbo. I grew up in this very turbulent times in Colombia, so I'm a product of that part of Colombian history. One of my impetus to go to medical school was to help people. I love treating people and try to know things, but also because of curiosity. In Colombia, at least at that time when I was training in Bogota, there were very few opportunities to do research to try to understand why we do things. So I had the opportunity at the end of medical school to have a program with a university in Boston, which basically changed my life. And I understood that I was very young as Lily, and you go straight from high school to medical school. So I knew that I could go in a branch of medicine that I didn't know what will be, but infectious diseases. Really was this area where I could do research. Could treat patients with influence, public health. Et cetera. And that's why I got the bug of infectious diseases. Thinking back to my country and then did my scientific training and funded by scholarship by the Colombian government in England for several years. I came back and I was at that time, and after doing a lot of research, missing patients because my contact with patients was not at the level I wanted, but the possibility to go the clinical training, I decided to go to the United States.

Cesar Arias: [00:05:40] I came back to Colombia. We set up units of research. We are still fully functional and expanding. I came to Houston because I had a mentor, Dr. Barbara Murray, who was very involved in antimicrobial resistance, and that's what I wanted. I've been in Houston since first at the University of Texas and now at Houston Methodist. During this time, I experienced all the challenges that a Hispanic has to do with being a foreigner, having to do through with a visa process, having to do with this waiver, you know, be very close to be ejected from the country. And in two weeks because your paperwork was not ready or being able to visit your family because, you know your visa is not up to date. And for foreign medical graduates, sources of funding, meaning if you choose a more research oriented career, are very difficult. I had the fortune that the NIH started this program called K99/R00: Pathway to Independence, but they will only giving five grants in the entire country. Getting one of those was really the start of my career and allowed me to actually solve even immigration problems. And thanks to having federal funding. Those are barriers that you have to go through as you grow in your career. I still love to be physician scientist and I love ID.

Carlos del Rio: [00:06:51] That's terrific. Well, Max, how about you?

Max Brito: [00:06:54] My journey started in Santo Domingo, Dominican Republic, the center of the Caribbean and the universe. I was born there, went to medical school, asked my colleagues, just alluded to in our countries, you have to go into medical school very early. It's not like like here where you have the luxury of college, think about it and do other things. So as long as I can remember, I wanted to be a physician, a doctor, and that was probably sparked by a desire to work with people. So I went to medical school there. After that, I kind of got the information that you had to pass these exams. So I bought these books and started reading from them. At the time, you know, you didn't have those Kaplan courses that people took to get into the US and pass the USMLE. So I got together with a group of people and studied for these exams, passed locally and then did a rotation in Miami because you had to have some sort of letter from folks. So a doctor in in Miami at the time of Dominican origin, Hector Jimenez, you know, gave me an opportunity to rotate with him. Then I went to Mount Sinai in Miami and did another rotation, and that's where I ended up in residency and befriended people there and then got into residency, didn't get a whole lot of interviews, got a few.

Max Brito: [00:08:17] Mount Sinai was one of them. And then I just matched them. And then went on to Jackson Memorial, where doctor Abbo now works, to do infectious diseases. After that got the opportunity of a lifetime at the University of Illinois because as a very young doctor, someone, the head at the time, said, I need a program director for the infectious disease fellowship. I thought I wanted to be a clinician educator. I didn't have any idea of what anything else entailed. You know, you learn about research and these pathways once you are an assistant professor, when you don't have the correct mentorship. I said, Sure, I'd like to teach. And then so I was hired to be the program director at the University of Illinois. I was in Pittsburgh for a year and a half, but basically I've been my whole professional career at the University of Illinois. There I did an MPH, started getting involved in global health. And then started doing some clinical public health related scholarly projects. I may have taken my last job there. So still here.

Carlos del Rio: [00:09:19] That's fantastic. So each one of you, quickly, if you were to say, what do you attribute your success to? Lilian, why don't we start with you? What are you what do you attribute your success?

Lilian Abbo: [00:09:29] That's a tough question because I always feel that I'm not successful enough. It's one of those imposter syndromes where no matter how good you're doing, you always feel that you can do better. My success, it's multifactorial. One, it's a lot of hard work. It hasn't been random. It has been a lot of intentional effort into putting my best face in everything I do. And I'm a perfectionist and I'm an achiever. I want to accomplish things. So I set goals and I put a lot of work into accomplishing them. Family. Family and friends. A lot of support and having that network because not every day is a sunshine, right? And having amazing friends, including Max and Cesar, who are my work friends, they're like my brothers from another mother. Having a network, it's important, both professionally and personally. Networks come in many colors. And then mentors. They're mentors at different stages of your life and your career and being grateful, staying grateful to those mentors because gratitude is as important. Faith and gratitude are as important to your success as anything else. And of course, a little bit of luck. You know, it's hard work. It's family, mentoring, support, but being lucky and being in the right place at the right time and also taking the road less traveled. You have always two choices in life and to me, taking the road less travel has been the hardest, but has also given me the opportunity to be more successful in areas where other people did not want to venture.

Carlos del Rio: [00:10:48] That's great. Cesar, how about you? What do you think your success is?

Cesar Arias: [00:10:51] I actually would love to hear your story about this, and you answered that question too. But anyway, a word that I always say is resilience. This is sort of a marathon I heard in a commencement speech once, you don't get too high when you are successful, not too low when things don't go well, just forward. Keep moving forward. Keep moving to where you want to be. And I think that's a key factor in all of this. There will be rejections, but there will be maybe few acceptances and there will be good moments, bad moments. Lillian got this right about trying to share your experience with others. Kindness and generosity also brings you enormous satisfaction in this profession and puts you to a level that you never imagined. So my word would be resilience.

Carlos del Rio: [00:11:41] How about you, Max? What do you think your success is attributed to?

Max Brito: [00:11:44] I think this combination of the same things that the colleagues have stated, you work hard. You know, there is a dose of luck, but particularly in my cases, I like what I do a lot. That has helped me move forward in a much pleasant way. Sure, there are things on my job that I don't like, but 80% of my job I like and love. And the most important thing is patient care and the people that I take care of that brings a lot of satisfaction to me. When you do something that you like, you're bound to be good at it. As Cesar said, if you persist, if you work hard and then you like what you do, you're going to be successful in what you do.

Carlos del Rio: [00:12:24] I always tell people that jobs sometimes are hard and you may not necessarily like them, but to me, throughout my career, what has determined whether I have enjoyed a job or not is who you work for and who you work with. The colleagues you work with, I think are critically important. And I think one of the things that I have enjoyed about the board of directors during my tenure there has been having colleagues like you on the board and collaborating and working together, because sometimes you don't necessarily agree with people, but you can disagree in a way that is respectful. And again, you're trying to do as Cesar said, you look forward, you're going to improve things.

Carlos del Rio: [00:12:59] So each one of you has devoted a great deal of time volunteering for IDSA. You have served the board of directors. You have done other things. What does IDSA represent for you and why have you given so much of your time to IDSA? Why should members volunteer for the society? Lilian, what do you think?

Lilian Abbo: [00:13:15] IDSA means a lot of things. It's community, the sense of belonging. It's family. IDSA has really opened the doors for me to meet amazing people, who are friends globally, not just within the US, has opened a network of people that think alike, but also different, smarter than me. I always like to surround myself with smarter people because if you are the smartest people in the room, something is wrong. So learning from others, that has been an amazing opportunity. And then the opportunity to contribute at a national level because we all do our jobs in our hometowns and you may have an impact at your hospital, at your city, maybe at your state. But when you can have impact nationally or internationally, like the board or being in the guidelines and writing, for example, the national or international guidelines for stewardship and really helping people globally implement things that that you can help them with, I think that's extremely fulfilling. Being in the board of directors and being able to set up a strategy for the society to open the door for other foreign medical graduates than us, for other women or Hispanics or other nationalities, to me is important. Like I always say, other people have opened windows and doors for me. For me, it's as important to open those and hold the ladder so others can climb with you. There's no point to being the top if you can't help others climb with you.

Carlos del Rio: [00:14:31] That's beautiful. Thank you. Cesar?

Cesar Arias: [00:14:33] I've been fortunate to be sort of attached with it for now, I think more than 12 years. When you go to a society and you see that society being transformed as you speak, that your ideas are taken into consideration and you see the transformation of the society, that creates a sense of citizenship and sense of family. As Lilian said, that is difficult to describe. I've been fortunate to witness that a society who had certain positions, who decided to change, to decided to evolve, decided to open much more and to try to be the best they can. And when you are a member of a society like that and you contribute to that transformation, that makes a mark that is invaluable in you. So and every time the society calls you are there, you are a soldier, you are a good soldier because you really know that you are achieving a higher goal. And without thinking about yourself or anything that particularly benefits you, you know that your efforts benefits everybody. And that's the reason of a society. And I found this in IDSA, and believe me, I just love this society.

Carlos del Rio: [00:15:47] Well put. Max?

Max Brito: [00:15:48] What is there not to like to participate in? Right. For a kid from the Caribbean, you know, networking with people who are the best at what they do in the profession you love. Why would you not participate in that type of activity? So, as Lilian mentioned, you can be part of guidelines. You can be part of the folks who are deciding and trailing the path forward. And I think that's very important for me. I was mesmerized. One of the things that you don't have in Latin America, that you have in the US, amongst a lot of wonderful things, is that ability of us as trainees, as student to interact with people who are way more advanced than we are and then treat them as, with respect, but more of an equal than in some of the countries. I mean, when I first came here and I thought that you would go to IDSA and you would meet the professor with John Bartlett, he was like. And then, you know, as grown ups now seeing our names, I'm sure that all of you, the first time that you opened CID and saw your name in the first page of CID as belonging to the leadership of this society, it was pretty special to you. So I think that it's community, it's professional home and it's just why would you not be part of that? It's only natural that you participate. The last thing is that if you don't advocate for yourself and for the profession, someone else would advocate for you. It's not going to be as good as you advocating for yourself. So we need to get involved because other people are trying to direct our lives and it's way better if we direct our own life and destiny. And that happens when you get involved in organized medicine and institutions, like IDSA. 

Carlos del Rio: [00:17:30] Yeah, absolutely. I think you make a lot of sense, and I totally agree with you. So as you know, the number of foreign medical graduates like us interested in infectious disease is increasing. Why do you think we need to do as leaders in the society to facilitate their career paths?

Max Brito: [00:17:44] We have a lot to give to these people. So we've been there probably in conditions that are not as open, as favorable as now. Regardless of the logistical and legal barriers, you can inspire these people to really come to the United States and become an infectious disease physician. And examples and stimulations and inspiration in the work we do that we can do whatever we want to be in this country. And I think it still is the case is a major driver for people to bring into the field. The pandemic is just an example that we need to utilize as a springboard to understand what we do exactly and how we can change not only the lives of people at the medical level, but policy, political will, etcetera. So I think we have the tools now, the communication skill, the communication channels to bring more people to our field from our countries to train them. Either they come back, they stay here, they will always have a major role to play. I, for example, love my country. I run several programs in my country. It's something that I'm very proud of. And I think you can be an agent of transformation in those countries.

Carlos del Rio: [00:19:04] Yeah, absolutely.

Lilian Abbo: [00:19:05] You have two options, right? You can come and bring people here. And as we know, there is a void. We don't have enough ID doctors to take care of the population of the US. But also there is a big need to train people in other countries, as not every country has solid infectious disease training programs and these are the people who also end up running the public health of these countries. And we live in a global world. So the more people that do infectious diseases and they are well trained, we're all winning. Right? In addition to that, ID attracts a lot of FMGs because whether you are in India, Africa or South America, we know that one of the number one causes of death continue to be infectious diseases. In many places, malaria is still a big problem. Many places, diarrhea and childhood dehydration and parasitic diseases are still a big problem. So when we grow up and that's our reality, we're attracted to trying to solve that problem. You can do that way more in ID than in plastic surgery or some other specialty. Also, in my case, we had very solid training in internal medicine and from all the specialties in internal medicine, I think ID to me was the most fascinating one. You interact with every other specialty. So for foreign grads, we need to open the opportunities to doing rotations here, the barriers to entry into our fellowship programs, having more opportunities and visas, which again IDSA does not always have the solution to fix the visa problem. But anything we can do to advocate, like Cesar said, I think it's a win. And also opening the opportunities for people to come here and go back to their countries. Not everyone wants to stay in the US or has the opportunity, but if we can help them get back and continue that network of support, it's a huge service to the rest of the world as well.

Carlos del Rio: [00:20:44] Absolutely. How about you, Max?

Max Brito: [00:20:46] I think the best thing we can do for those who come after us is sponsorship and mentorship. And there's one thing that we should consider, especially now, talking to the mentors that are listening to to this podcast for underrepresented minorities and for Hispanic kids is no different. I mean, there are two types of Hispanics that you will encounter. One of them is the person like us who comes from another country, a very diverse background, and we're Hispanic, culturally bound to the people who constitute the second group or perhaps the first group, which is the people of Hispanic origin that are born in this country. The mentorship that you provide has to help them navigate the system. The person who comes from abroad doesn't understand the system very well. So if any sponsorship or any mentorship that you can provide in helping them navigate, everything from abbreviations to how do you find a mentor, that is crucial because we don't grow up with these things. So it doesn't come natural to us. Now, the Hispanic kids who grew up in the US were born in the US. You know, they know all of this, but they're not very likely to ask you for things because it's a cultural thing. I've had students that come to my office from different backgrounds that they're not underrepresented minorities and they knock on my door and they ask me, Can you nominate me for this award or could you nominate me for this position? I mean, they know what needs to be done to get from point A to point B.

Cesar Arias: [00:22:24] Now Hispanic kids who grow up in the US, they may know that, but they're not as likely to knock on your door because there's something cultural. We don't ask for stuff like that. It's not ingrained in the DNA. So if you see someone that is really good and you would like him to see your program or you would like him to see serve with you in a committee, then ask him and say, Hey, do you think you want to serve in this committee? I think that you were a good candidate for this award. You will get a response much more likely than if you let it to the candidate, which is more or less the way we do it. So realize that. And then it's highly rewarding when you take somebody as a mentor, when you take somebody who you think has a lot of potential and because of something you did, that person achieved something and someone did that to me. Someone took me to organized medicine, to the ACIP, to IDSA. It's highly rewarding because then you see him in a position to affect change and that is because of something you did. Do not feel threatened for who's coming behind you, feel honored that you're able to help their career.

Carlos del Rio: [00:23:30] Absolutely. So let's just close our podcast by sharing your advice to young foreign medical graduates, especially those of Hispanic origin. Lilian, what would you tell them? A few words.

Lilian Abbo: [00:23:41] Follow your dreams. Don't take no for an answer. The path is not going to be easy. Success is not a straight line. But if you're resilient and you have a goal, surround yourself with the right people and stay humble. Don't think that you know all the answers. This is not Latin America. This is really hard work and do what you need to do to get there. But if I could do it, you can do it too. We're here to help you.

Carlos del Rio: [00:24:06] How about you, Cesar?

Cesar Arias: [00:24:07] I would say keep going. Work hard, but work smarter too. And that means identify the people who can help you. Take a leap. Contact these people. We are here to help and we are generous. And in general, our community is very generous. Don't lose hope. That's very important. Never lose hope and keep going.

Carlos del Rio: [00:24:28] Max, how about you?

Max Brito: [00:24:29] The good thing about coming third in this intervention is that I can point out to what they said and said whatever they said, add because I would echo what they just said, I mean, you follow your passion, but I would add network, try to network, try to establish community, try to leave the profession a little bit better than when you found it. That is key. And so you would meet wonderful people. You would get to affect change in things that you never dreamed were possible. And then very, very importantly, seek us out. Find us. You don't have to find the four people that are in this podcast, but you know what I'm talking about. Find people that went through your same path and do not be afraid to ask the questions, to ask for help because it is very likely, there are exceptions to every rule, but it's very likely that everyone who went through the same thing you going through is going to help you out. So seek those people and take advantage of that sponsorship of mentorship.

Lilian Abbo: [00:25:31] I want to add two things. One is get involved with IDSA. As a student, as a resident, as a foreign grad, there are opportunities, there are pathways. And if you don't see them, contact IDSA and say, Hey, I'm a foreign grad, I want to get involved. How can I contribute? So don't always ask, What can you do for me? But what can I do for you and what can be your contribution and get involved early because we will find a way to get you involved and to come to IDWeek and come to the Latin party. Meet a lot of fun people because that's another way of informally networking and you will not regret it.

Carlos del Rio: [00:25:59] Yeah, no, I'm glad you said that because I was about to say one thing that I like about my Hispanic colleagues, about the Hispanic culture, is, yes, we work hard, but we also party hard and we like to dance and we like to listen to music. And I tell people, yeah, come to the latinos and infectious disease party at IDWeek. It's a great opportunity to meet people. It's a great opportunity to network informally and to have fun. And this is a community. This is a family. Vamos todos para ayudarnos. Thank you for your time. I really appreciate it. And thank you for everything you have done and you continue to do for the society, for the profession. You are all leaders in the field. I greatly respect you, but I also feel privileged to have you as friends and colleagues. Have a good day and thank you for participating.

All: [00:26:40] Thank you. Thank you.