Dr. Kamiar Alaei, Chair of Health Science at California State University Long Beach: Lessons From a Global Health Hero

Van Ton-Quinlivan: Welcome to WorkforceRx with Futuro Health, where future-focused leaders in education, workforce development and health care explore new innovations and approaches. I’m your host Van Ton-Quinlivan, CEO of Futuro Health. Today, I’m delighted to welcome an award-winning academic, human rights advocate, global health hero — and I’m proud to say — Futuro Health partner, Dr. Kamiar Alaei. Dr. Alaei has too many credentials to list but I can summarize by saying he has earned degrees from Harvard University, the University of Oxford, and top universities in Iran and has held academic appointments at the State University of New York, Drexel University, and Oxford. His current work includes being an external university examiner.

His work has focused on HIV/AIDS as well as health disparities, the linkage between health and human rights law, and health diplomacy in the Middle East. What amazes me is how many countries he touches in the work that he does. And his day job is being department chair of Health Sciences at California State University Long Beach. Futuro Health is working with his university to grow the public health IT workforce, thanks to a federal grant. Thanks so much for joining us here today, Kamiar.

Dr. Kamiar Alaei: Thank you very much for having me.

Van Ton-Quinlivan: Kamiar, as someone who has received the California Steward Leader Award, I immediately sensed the civic stewardship in you. So, tell our audience what came to shape you and your worldviews?

Dr. Kamiar Alaei: That’s a wonderful question. When I grew up in Iran, as you know, there were a lot of people who are affected by the society due to social isolation and stigma, and also some of the human rights violations. So that motivated me. How can I better serve them? And one of the key elements was, when I was studying at the medical school, I realized people living with HIV/AIDS…their rights were being violated. That was my main motivation to establish the first HIV program in the Middle East in Iran, which was documented by the World Health Organization as a best practice in the world.

The first study I conducted was to see what was the main cause of mortality, and my initial thought was, maybe it’s due to opportunistic infection due to lack of access to medication. But surprisingly, 58% was due to suicide. They committed suicide during the first year after they saw conversion — which means they had ten to twenty years to survive — but decided to terminate their life due to social isolation. So, I realized more than medication, they needed social support, they needed psychological support, and that was how I started the initiative.

Van Ton-Quinlivan: Thank you for sharing your insights on the work that you have done there. Now, tell us about your journey into healthcare and how you managed to have a global impact, Kamiar.

Dr. Kamiar Alaei: This is really important. When I was working on HIV/AIDS…as you know, HIV doesn’t need a visa to cross countries. This is really a global concern. That was my motivation when I started the program. In Iran, I realized that a lot of border countries have a similar culture and language and they are facing the same challenge. That was my motivation to scale it up. We had visitors from more than fifty countries. They came and visited us, and I went to more than forty countries to present our activities and build up more partnerships and collaborations.

We scaled up in the Middle East and North Africa, Central Asia, and later with the Pan American Health Organization, which is part of the WHO.  Then over the next few years, we realized there are other pandemics besides HIV/AIDS, like hepatitis — which I was working on — and recently COVID. Over the past two and half years, we realized how it’s very essential that if one country doesn’t do their job, all the globe will get affected, so it’s very important to work together.

At the same time, you realize who are the most vulnerable populations, and how we can make sure to protect their rights and to promote their access to services in the right manner. This is what we see today. There are a lot of minorities that have less access to COVID testing, vaccination and medication, among other things, and it shows us how it’s very important to revisit what we have done over the past few decades to make sure we reduce the gap of health disparities.

Van Ton-Quinlivan: Kamiar, many of our listeners are in the world of workforce, and workforce tends to be not an individual sport, but a team sport. So, when you talk about collaborations and partnerships — especially even crossing national borders — could you give some insights on how you even begin figuring out who to work with? Are there any tips that you would provide based on your collective knowledge?

Dr. Kamiar Alaei: A very important thing when we talk about workforce is, who is your audience? Is it public or private sector, is it not-for-profit, among others, and what are the desired skills and competencies they are looking for? We have to develop our trainings and our educational packages based on the current and future needs rather than what were the prior needs. There was a disconnection on this in the past, particularly in public health.  In engineering, you see they are very up to date, they are very linked to the skills, and those training programs are designed to get those skills ready to go to the job.

But for public health, it was not very clearly defined. In medical school it is defined. I went to medical school and I developed a lot of training for doctors. It’s very clear what kind of competencies and skills they need to get to see patients. But for public health, it has gotten a little weak, and this is a time to go back and revisit. Because the lesson we learned from COVID-19 was really that we were not ready for those emergencies, and now it’s time to work with those targeted organizations and revisit our curriculum and revisit our educational packages based on the needs assessment. It should be ongoing, and I think this is very essential. This is a time to go back and revisit and also encourage the right audience to come to these public health programs, because sometimes they come to public health as a transition when they are actually seeking other programs that they are not ready for yet, but in the future, they may get ready for.

We need to define what public health means, and get a new pipeline of students that are eager to serve the community and to promote public health in a bigger definition. I think this is our responsibility. So, from one side, to engage those organizations, from the other side to revisit it in academic institutions and curriculum development, and also to motivate a new generation of students who will be the future leaders in public health.

Van Ton-Quinlivan: We are doing some very creative work with you to grow the public health IT workforce here in California, and of course once that infrastructure is set up, it’s applicable to the rest of the country. I just want to give praise to the curricular redesign that you’re undertaking. I want our audience to know that this involves collaboration between several four-year systems.  In California, we have the University of California system, we have the California State University system, and we have the community college system, and so what is brilliant about this model is that the curricular design is transcending all three systems in order to move students through from certificate to degrees. I would love for you to share how you’re approaching this, and what the workforce issue is that is being addressed.

Dr. Kamiar Alaei: Based on COVID for the past two and a half years, the main challenge was how we can have timely decision-making based on evidence-based inputs from all the data regarding testing, hospitalization, tracking, and tracing, among other data points. Informatics is definitely very essential to this and to linking all of those data together so we can make really timely decisions. So that was the motivation that brought us together for the first time — different layers of the public and private sector, nonprofits, and academic institutions.

Instead of putting out some existing courses and offering them to students, we made a year’s effort and went back and developed a survey. Based on the survey, we reached out to different audiences to identify what are their desired skills and competencies based on the current challenges that they are facing and for hiring new staff in the future. Also, we did data mining by looking at more than 500 jobs which were posted on the internet to see what were the list of skills and competencies that they’re looking for, and we compiled all of those inputs.

Then we came up with different modules and different courses. To make it more consistent, we defined the different levels of certificates as associate degree certificate, undergraduate certificate and graduate certificate so it would be more connected, not just a scatter of different courses. In this way, we make sure they get all of those skills and trainings to be concluded with a paid internship in a desired organization that they are eager to collaborate with. I think this was very essential.

You know, there were some other organizations that just use existing courses, but we made a lot of effort, which for the future I think will be the gold standard of how we can develop training based on the current and future needs. Every year, we have a review of those courses to make sure they are on track because the needs we have today may not be the need we have four years from now. So, there will be ongoing assessment of those courses.

Van Ton-Quinlivan: Maybe you can comment a little bit about how students will transition between their certificate program gained at community colleges into the degree-bearing programs.

Dr. Kamiar Alaei: We have different packages; we have not-for-credit; we have non-credit; and full-credit. And thanks to Futuro Health for taking the lead for not-for-credit. It’s very essential we have a broader reach, to be more inclusive, so that everybody is welcome to apply. Then, over time — if they decide to make it full-credit — we have a kind of practical learning assessment to see what are those experiences that they have had, and what are those not-for-credit courses that they took, to make an equivalency of for-credit. And also, for those that are seeking to get an undergraduate degree, there’s a way that they have the opportunity to transfer.

So, we made all of these interconnected and that’s the beauty: that students from everywhere in California can take any course from the community colleges for free, and then they can take an additional course at respective institutions at Cal State University or UC Berkeley, among others.

Van Ton-Quinlivan: The concept that Kamiar has laid out is really the concept of stackable credentials so that adults don’t have to start from scratch each time they go to the next institution. It is so innovative, and it takes so much leadership. I just wanted to share that we were speaking to someone who leads a big division at the Health Resources and Services Administration (HRSA) at the federal level. She’s so interested in this model that she’s inviting both of us to go talk to her senior staff and share what can be done.

I also mentioned to the Colorado Governor’s office that this can be done, and so there’s so much interest in how to move students across systems because sometimes the workforce need is at the certificate level, sometimes it’s at the associate’s level, sometimes it is at the bachelor level and then beyond, right? And then again, education is not just one time. You have to go back and upgrade constantly. So, everyone’s looking at how do we design this so that adults can actually move through education and keep on reacquiring education.

Kamiar, in your day job you are department chair of Health Science at California State University Long Beach, and I was wondering if you can share your approach to working with students who are interested in the health professions. What do you think they need to be learning in this challenging time for public health?

Dr. Kamiar Alaei: It’s very important how we can inspire them and motivate them and show them the bigger picture, because public health gets confused with other health sciences. You know, a lot of people maybe want to go into the medical field, which is great, but they don’t know how public health can help them.  There are a lot of doctors that also have public health credentials, or work in public health departments. As we know, there are a lot of directors of Departments of Public Health who are doctors or other medical providers. So, in our department, we try to provide this information.

We created a new course, Introduction to Public Health, to get them exposed at the beginning before they take other courses. We developed a lot of new concentrations to give them different choices. We have a Health Policy Advocacy Concentration, we have a Health Minority Concentration which will be the first time, to my knowledge, that they can get different courses like African American Health, Asian American Health, Latino Health…they can get all of those individual courses and get a concentration in Minority Health. Also, we have a new Mental Health Concentration, and then we have pre-health professionals for those who want to pursue a clinical field.

We also have been working with some of the other institutions to pursue a doctorate in Public Health for the first time. We are very fortunate that the California State University System went to the State Senate and they just approved it last month. It will be ready to go to the Assembly and the Office of the Governor, and by the end of summer, hopefully, it will be approved. It will be the first time ever in the history of CSU that we can offer a terminal degree in Public Health which will be another motivation to say, “If you come to this track, you can earn the terminal degree and all will be applied.”

We shared case studies with them because those cases make more tangible what the challenge is and how their leadership and innovative ideas can solve the major problems. Instead of just seeing patients individually, you can have an impact on thousands, hundreds of thousands, or even millions.

Van Ton-Quinlivan: One of the experiences that Kamiar tackled in building up his experience to take on the public health workforce was his role in educating doctors in the war-torn country of Syria. We have a shortage of doctors here in the United States, so I would love for you to share more of how this was possible so that we can learn some lessons to apply here in the U.S.

Dr. Kamiar Alaei: Sure. In the conflict in Syria, unfortunately, over 500,000 were killed. We were informed a few years ago that there was a shortage of physicians. Ninety percent of doctors left in those provinces that we were focusing on, and the remaining doctors were just in a significant shortage. Also, there were medical students, but their university was completely destroyed. So, we had a conversation with them and we did some need assessments in collaboration with some of the faculty to see what are the courses that are in need. Then we developed those courses and we developed online programs for 525 medical students.

Because they couldn’t speak in English, we provided English training programs to make them ready for the future. At the same time, the challenge was that they were internally displaced. As you know, there are lots of UN mandates for refugees that are in other countries, but there’s nothing for internally displaced refugees which created an additional layer of challenges for delivering education online. We did surveys and we realized 90% of them had no computer. Then how can we deliver that? Fortunately, more than 70% had a smartphone. So, we developed an app that we were able to use to deliver online education. They were very committed and they were very engaged and we were able to help them and provide more mentorship and get them engaged.

We had some female students tell us traditionally, when we went to school, we had to have our brothers be our bodyguards, and we were separated boys one side, girls the other side. We couldn’t communicate. But through this online platform, we are able to communicate. There is no physical distance, and they were very excited about that. Fortunately, last year a lot of them graduated from the medical school and they are ready to take on a lot of medical services, which are in need.

Van Ton-Quinlivan: Your story is very inspiring for this audience to understand what is possible…all the obstacles that were in the way, and yet you were able to effectively navigate them. So, congratulations.

Dr. Kamiar Alaei: Thank you.

Van Ton-Quinlivan: Our listeners are undoubtedly getting a sense of your courageous leadership — whether you’re busting through different systems in order to create a doctoral program that is a first, or working across barriers to tackle a public health challenge. Give us some additional glimpse into the courage that you’ve had to display. I’m sure that there’s a moment where it was a sort of scary issue for you to tackle, and I wonder if you can share what that situation was, and how you went about it?

Dr. Kamiar Alaei: As you know, I have been working on HIV/AIDS in the Middle East, in Iran, which was more conservative. When we worked on very specific health concerns, including HIV/AIDS, we’re working with key populations including LGBTQs, prisoners, injecting drug users, and sex workers, among others. There was some resistance by some stakeholders. For example, they asked us, “We heard you wanted to work with sex workers?’ So, we tried to reduce sensitivity by rephrasing that we wanted to work with vulnerable females. They said “Okay, vulnerable females. No problem.”

Instead of touching the more sensitive issues, we started with the less sensitive issues. We said we wanted to protect new babies from getting HIV/AIDS and that saving one life equals saving everyone’s life. There’s no religion against that. They said, “Okay, that’s fine. Protect new babies so as not to get a child with AIDS.”  So we said if we want to protect new babies, we have to protect mothers. It is the prevention of mother-to-child transmission. “Okay, no problem. Mother to child.” Then over a year we said if you want to protect the mother, we have to protect the father and using a condom is one of the ways of prevention. So they said educating about condoms was fine.

And then all the time as we reached out to other more sensitive topics, we tried to identify some of those cultural approaches or religious approaches that can open the door. For example, in Islam, drinking alcohol is prohibited. But, if you’re in a desert and you cannot find water, you can drink alcohol to save your life. This means between bad, which was alcohol, and worse, which was to die, bad is better. We used the same argument to talk about harm reduction: using a needle exchange program, methadone maintenance therapy, and talking about condoms. They defined these things as bad, but to lose life was worse.

I call this a way of how you dance with partners. We tried to dance with them, to find ways, because there’s always a difference in agreement, or different controversies. When we talk about a certain medication among medical doctors who got the same training, there’s debates and controversy so how do you expect that religious leaders, who have no training in specific medical subjects, should understand everything?

I call it a “river strategy.” In nature, there is no river that goes straight. It goes and changes ways so we try to be more flexible, but be consistent. In this way, we were able to engage a lot of those who were initially against the initiative to be more supportive.

Van Ton-Quinlivan: I appreciate that story about dancing with partners, and how to go about solving problems creatively and taking advantage, or making use of, the cultural context as a way to design the solution. Let’s close by inviting you to share with us what’s ahead for you and your work and what excites you most about the work ahead?

Dr. Kamiar Alaei: I think the key for us is that health is very interdisciplinary. How can we engage different faculties from different disciplines to work together, which is what we have been doing, as you know, for these current clients of public health informatics and technology. But we want to scale it up. So, we have been working to establish a new School of Population Health and Public Health which will be interdisciplinary. We have faculty from different departments — Computer Science, Biomedical Science and Information Systems, among others — that they will join us. We needed to start with two departments initially, but we’re hopeful to get more academic faculties from different campuses and also engage the public and private sectors. We need to have more interdisciplinary education programs, more interdisciplinary applied research, and engage and attract more students motivated to make the future a better future for all of us.

Van Ton-Quinlivan: Well, certainly the future will be a better future, so thank you for your leadership. You know, Futuro Health is so proud to be in partnership with you. You have vision, you have a big heart, and you have the practical mindset to solve very difficult challenges, and that makes you a perfect partner for Futuro Health. So, thank you.

Dr. Kamiar Alaei: Thank you very much. I’m so honored and delighted to be a part of this initiative, and I want to thank Futuro Health and your leadership, your visionary leadership. I think it is very important how you take all of those efforts to show the shared social responsibility that all of us have beyond our day job.

Van Ton-Quinlivan: Thank you again for being with us today, Kamiar. I’m Van Ton-Quinlivan with Futuro Health. Thanks for checking out this episode of WorkforceRx. I hope you will join us again as we continue to explore how to create a future-focused workforce in America.