Share Public Health Podcast Transcript: If there’s not an opportunity, design it. An Interview with Captain Aisha Mix.

Laurie Walkner Welcome to Share Public Health, the Midwestern Public Health Training Center’s podcast connecting you to public health topics, issues, and colleagues throughout our region and the country, highlighting that we all share in public health. Thank you for tuning into this series of interviews with public health leaders where we learn about different perspectives on current and emerging public health issues.

Suzanne Hawley Hi, my name is Suzanne Hawley, and I’m from the Midwestern Public Health Training Center. Welcome to the public health leadership series where we get to talk about strategic public health skills, but from a real public health professional from a personal perspective. So, thank you for joining us today, it’s very nice to meet you. I’m wondering if you can just introduce yourself and say a little bit about how you came into public health.

Aisha Mix Sure, sure. so my name is Aisha Mix, currently a Captain the United States Public Health Service Commissioned Corps. Most people are familiar with the other services, we are one of the seven uniformed services, and so what we stand to do is to protect, promote, and advance the health and safety of the nation. How I got into public health, I tell you, I always- I’ve always enjoyed kind of working for people, right? My desire to become a nurse came from wanting to understand how people experience disease, how people experience wellness as opposed to really learning about the disease itself, you know? Through my nursing training and then also through graduate school, what I realized also is that my connection was more so with the community and understanding, you know, what are the- the pieces of the puzzle that make a person who they are, you know, why did you make that decision? What is it that you brought with you as a person that made you do that? You know, whether it was that thing you were supposed to do with that thing you were not supposed to do, it wasn’t until later that I realized that that actually was more public health, so I moved from kind of working with individuals and families to looking at communities and populations and kind of more large scale approaches. Coming into the Public Health Service was really just kind of my way of formalizing it and really being on a national and federal level to impact the decisions and the policies that were being put into place.

Hawley Well, thank you for explaining a little bit about what the Public Health Service is, and I’m just kind of curious what’s that been like for you to be in the Public Health Service?

Mix Yeah, it’s been fantastic, it really is- we call it the best of both worlds. We have our kind of regular day-to-day jobs, if you will, which are truly our assignments where we’re placed. Many of us are within HHS agencies. Myself, when I came into the Corps, I was originally at HRSA, which is the Health Resources and Services Administration. That was a natural place for me. The focus of hHRSA’s work is on providing access to care for underserved populations, so in that role, I then moved into policy with respect to nursing education as well as health workforce. Fast forward to now, I’ve been able to work within the Office of the Secretary. I’m looking at policy across HHS and now I’ve actually stepped outside of HHS with the Department of Homeland Security where I currently serve as a senior health policy administrator with the ICE Health Service Corps, so it’s been a great opportunity to not only engage in my day-to-day, but to also be a part of our international and national deployments as well. So, as I said, kind of that one foot and on both sides. It’s the idea that we have the day-to-day, but in the event of disasters and public health emergencies, we’re deployed to actually support local communities as well.

Hawley So, the work that you’re doing right now is incredibly timely and incredibly important ,so thank you for, you know, taking on that burden for- for the rest of us, and I’m wondering with all of these really cool kind of perspectives that you must have, what excites you most about public health right now?

Mix Really being the voice of people truly that, that’s really the basis. Really again going back to understanding what people, who people are, you know, what makes you- you, recognizing that the individual and/or the community are the experts in the care of themselves, so the same way that as a nurse working with individuals in a hospital setting. You’re looking at that individual to assess their needs and figure out how you can actually improve their health based on how they see health, right? It’s the same conversation with population health and public health and communities, you know, being able to learn that community, learn what makes it a community, then use those facets and those aspects in order to create and strategize on how to improve health. Because, again, it’s not a matter of coming with a prescription, you’re really coming with an idea that’s informed by the experts, the people themselves, so I think that piece of really moving to a point where we’re focused on the unique aspects of community as opposed to creating kind of a blanket approach and laying it on top of a community, so I think that for me is the most exciting piece because more at that point the ability to infuse diversity, infuse culture into the work that we do, I think is the most exciting piece right now.

Hawley Wow, that’s great. And certainly with the things that you’ve been involved with you can see just how public health can change so quickly, and so much to prepare for the 21st century, so with that in mind, I’m wondering:what kind of skills do you think that public health professionals should know or consider in managing change, leading change, just kind of change management in general?

Mix Right. I think that as an individual public health practitioner the best gift you can give any community is self-awareness. Your self-awareness of not only your level of expertise but who what makes you- you- you know, because it’s the combination of your experiences that you can actually end up sharing, and oftentimes people struggle with this notion of, you know, I’m not an expert, what’s my area of expertise? Your area of expertise is you- you know, and so I think self-awareness and knowing what you bring to the table and what you have to offer- communication skills- the ability to not only listen, but able to repeat back what you heard, and then an ability to translate it for different audiences because I think by nature public health brings together different stakeholders, and so to be able to translate the needs of one group to another? That takes listening, active listening, it takes understanding, and it takes an ability to communicate that to others who might speak that different language, you know, coming from different aspects of the community, and it- it’s an openness, willingness to learn. Being an eternal learner, because at the point that you think you know everything, it’s actually the point that you know nothing, right? And so the- the ability and the expectation that you’re approaching situations to learn, and then from that from that education that you receive, and then implementing, so I think it’s it’s back to the basics.

Hawley It truly is back to the basics.

Mix Because public health is a field that, you know, we create public health practitioners by virtue of the experiences that they bring to the collective conversation, and so once you can get back to the basics of what connects them all, I think that’s really the concept of public health.

Hawley So, I’m just really struck by just the deep respect that you are communicating about the importance of the individual and therefore the unique experience of a community, I mean, it makes me feel emotional just hearing you because I think that is a very difficult skill and priority to a purpose to keep holding on to…

Mix Yes.

Hawley And in all this work and so you know I- I guess I’m inspired by that, so thank, thank you so much. But also, I want to know I want to pick your brain what kind of partnerships do you think are important in- in making progress on this important work? Especially in terms of issues like health equity?

Mix Sure, I think it’s- it’s a combination everyone talks about, you know, research, academia, practice, and that partnership, but it’s also stepping outside the box to understand that not only is health in all policies, but health is in all aspects of living and, so you have to reach to these sometimes more unnatural partners, right? Understanding that even within business, you know, businesses cater to what people want. And if we’re in the business of people, it’s understanding the unique connections with respect to the business environment and getting them to understand the same philosophy that drills down to the needs at which translate to the health and wellness of the individuals not only that are working in their business, but that serve them and being able to impress upon people that health does not exist in a vacuum, and so being able to get people to see that intersection so it’s not only business, but it’s also legal aspects understanding what it means in the, you know, as I said I’m at Homeland Security right now and so in a world that is focused on law enforcement, right? It’s a law enforcement agency. How does health intersect even with law enforcement. So business, so law enforcement, of course the education, of course practice, definitely research, because I think there’s a story to tell, especially as it relates to public health nursing to understand that it’s not only us being at the table of implementing, as you know, people have mentioned nurses being the doers, but also at the forefront of developing ideas establishing research that is based on our principles and what we see as the priorities. And again, that brings us again back to that- that conversation of person. So, I think it’s, you know, identifying your natural partners but also reaching to make sure that some of the- those that don’t necessarily come more naturally are seated at the table as well.

Hawley So, I’m just visualizing you with a business leader or, you know, one of those unusual suspects, but kind of partnering with them and even helping them look. I’m just thinking of a snowglobe metaphor, this is- this is what I see, this is what my experience is, you know? What do you see bringing yourself, your own natural individuality, your story, your self awareness? And I want to know how systems thinking concepts have- have helped you in your leadership role as an individual leader?

Mix Yeah, that’s actually one of the skill sets that I’m most proud of is really truly looking at, you know, and for me systems thinking is, you know, what is the nucleus? And then you’re kind of building out to look at all those different levels of impact, two levels of engagement, and so again, with a- with a person-centered focus, as has always been my approach, is understanding that- that it exists not only for him/herself, but as part of a family, right? The family exists as part of a community- that community might exist as part of a neighborhood, and then as you grow these bigger concentric circles, that’s the system that you’re working within once you get all the way out into that kind of outer look, we’re really looking at what is the political climate, right? What are the overarching layers that impact all the way down to that nucleus? So, for me, systems is looking at every facet you know. The biological cycle by a cycle social, cultural, and spiritual, is what I lean towards- oh and so systems from me is a reflection of all of that, so not only internally, but externally. As I said, you get to the outer layer and now you’re looking at the organizations, the agencies that actually impact all those different areas of the community or the individual.

Hawley So, to do this work that you’ve described is seems kind of daunting, so I’m thankful that you have that- that’s- that skill set which is critical for everybody in public health, but I’m wondering, you know, a persuasive communication is another strategic skill that people talk about is critical, and I’m wondering for you, I kind of have some guesses of what might be important because you really demonstrate in your communication some deep respect for- for others, and you said listening earlier, but I’m wondering what- what do you see as pieces of persuasive communication that are things that people should be thinking about?

Mix Sure, um confidence, you know, regardless of what you’re saying, you know I could be saying the alphabet, when you say the alphabet with confidence, people will listen, right? If you’re not quite sure the order of the letters, the next thing that comes out of your mouth people are not quite sure of as well, so I think confidence is definitely a baseline for persuasive communication. It’s also an understanding and an ability to listen for a shared goal, because oftentimes you may not have the same- same approach in getting there, but you can actually find something to agree on. and so you speak to the agreement as opposed to speaking to the conflict, and so oftentimes at that point you’re able to persuade or influence others in their thought process, even if it’s not to move all the way over to what you’re saying, but it’s at least a willingness to be open to hear it and to consider it, because oftentimes, you know, getting people to consider your perspective makes them at least open to changes because to me, I think it’s more impactful to people, for people, to make informed decisions, right? Even if it’s not the decision that you would want or you would make yourself, but the fact that they were informed on both sides of a conversation and then made a selection as opposed to me- I’ve been closed-minded, or not have all the facts and make that decision in a vacuum. So, I think it’s- it’s the confidence, right? It’s also the- the listening and the communication skills that I mentioned to understand what that shared commonality is and then speak into the agreement as opposed to speak into the conflict. And I think those are those are three prime pieces when it comes to persuasive communication.

Hawley Okay, those are great, and I want to repeat those for myself because I want to say the alphabet in the mirror tonight with a lot of confidence-

Mix That’s right.

Hawley -and, and, and the key of listening, and really it sounds like you’re talking about you need to have faith in the communication process versus manipulating a specific outcome –

Mix Yeah.

Hawley and, and then to think, okay what are- what are the wins here we’ve we’ve covered today as opposed to well we didn’t get that done or that done, so I really like that more positive proactive kind of perspective that, that you’re pushing out there and those things can really- I think be helpful that you put it in those three ideas. I’m wondering what else have we in terms of what we’ve talked about today can you think that might be helpful for future public health professionals or skills that you think are really important that- that we haven’t talked about today?

Mix Sure, I think the only thing I haven’t touched on that’s something that’s- that’s important and near to me is just diversity within the public health workforce and an understanding in the same way that we talk about direct care services and clinical services and having probe- that reflect the community that they’re serving. It’s the same concept, even in public health practice, understanding that entering a community A- it takes invitation, right? B- It takes linkage with those community gatekeepers to really have access to the people, and then third, it’s an appreciation. It’s not a matter of saying that you have to be a member of that community, but it’s an appreciation of what they reflect. It’s always going to be easier if you have someone from that community who can then help you convey the messaging, so I think expanding for us to make sure that we’re reaching into the schools ,make sure that we’re reaching individuals that look like the communities that we serve with respect to the public health service and disaster management, which is what a lot of the public health nurses in the Corps are engaged in. It’s really understanding when we talk about the most vulnerable populations and the most vulnerable communities, oftentimes they are communities of color, right? And so, if we want to make sure that our public health nurses and public health practitioners are prepared for disaster management to support the most underserved and the most vulnerable populations, we have to make sure that a- we have public health practitioners that look like the communities that we’re going to serve, but it’s also awareness- a recognition that oftentimes those who are most vulnerable before an emergency or disaster other ones are going to be the most at risk even afterwards. So, diversity I think is one theme that I think we may not have touched on as much. but is equally important.

Hawley And thank you for adding that issue of diversity, because when I hear you talk I- I don’t think of just when you say what someone looks like from the community that they may physically look like you, but they also can look like you in terms of personal experiences, connections values, culture, spirit, spiritual ideas, so that really you’re looking at the individual person and- and who that might be might not be what you’re thinking apps in terms of diversity and making those connections more accessible to other people, so I kind of just want to keep talking to you about this because I think it’s really important that we- we think we know what that looks- what that can be and we can check off the box, but we still have the same processes and same policies that don’t allow for anything more than that.

Mix Correct.

Hawley So, I guess I’m just going to ask you in a confident voice: what do we need to do to kind of push that to help people kind of remember what you’re saying about the importance of bringing diversity to the workforce so we can better address our community needs?

Mix Sure. I think it starts with, you know, a respect and a celebration for each- and each individual person in your programs, right? So, if we’re talking about when you say, how do we start? So, there’s the start. That’s in the health professions program, so the development and creation of these professionals, right? So, even in that vein, it truly is- is not only an appreciation, but an ability for each person to celebrate who they are and their individual uniqueness, right? Once you’re out into the workforce, it’s the ability to connect with someone on a personal level, because you don’t know anything about a person until you’ve been able to engage with them on a personal level, because, just as you said, I can look at someone and I can kind of, in my mind, based on my past experiences, decide who you are or who you represent, but it’s not until a conversation with someone that I can actually learn who you feel you represent- because that’s actually how are you going to be carrying yourself. So, I think it really boils down to just a celebration of the person and an opportunity for that person to not only clean their expertise in themselves, right? As well as the outward facing providing opportunities for leadership, if not creating it yourself right, but seeking out and securing leadership opportunities and then also having a seat at the decision-making table, because everywhere you should expect to see that same layer and level of diversity, not just in pockets, right? Because, again, this is a thread that should be infused across everything and not just kind of anise, and not sitting in a corner, you know, that office you call on to increase diversity, right? This should be the thread that’s expected, and when I say expected, that also means that there are measures that determine how well you’re doing. It’s not just kind of a nice thing, it’s actually a requirement.

Hawley Sure, and thank you for- for that really bottom line that we have to also be respectful of and I- I’m thinking, you know, you’re in a leadership position, so when you just talked about developing other people or finding the opportunities for people to- to grow, what would you give for advice to someone who’s just starting out in public health and, you know, might need some advice? They might be more shy to- to know what kind of opportunities can I take? What do you mean by leadership? I just, you know, I’m trying to figure out how to- figure out my degree to what you’re asking me to do. So, any thoughts about that?

Mix Right. You know, I think there’s-there’s a difference between, you know, leadership and being a leader, right? Because you can, you can show leadership, right? You can have leadership qualities without being the head of the organization; without being the face of the organization.

Hawley So, leadership is an action?

Mix Correct, correct. And so it’s, you know, you hear people say: lead from where you are, you know, bloom where you’re planted…things like that, and so for someone just starting out really, my- my best advice is to follow your passion, right? Because when you’re following your passion and you’re working within the areas that are most important to you, it never feels like work, you know? It always feels like fun, because these are the things that you enjoy learning about, these are the things that you enjoy making a difference in, and so when you follow that passion and and let the job title, you know, it’ll come, it’ll happen, it’ll… and if not? Design it. But again, if you follow your passion you’ll never go wrong and so also what I’ve learned is that following your passion also then places you naturally and opportunities for leadership because it goes back to that conversation of confidence, right? Because when you are competent to lead, people believe in you. When people believe in you, they’re more likely to follow you. And how do you, a leader people deciding to follow someone. So, I think it all starts in your passion. It’s nice to see people in their established jobs, and, you know, see someone who’s very successful and take that title and figure out what do I need to do to be that person? But I think that- that sometime’s misguided because it maybe there’s a different walk that- that person has had to get to where they are, and so it’s really a look at an appreciation for what they’ve done in their path, but to bring it back to center and figure out what about that is. What I enjoy what about that I am gravitating towards? And then create your own path that follows kind of your interest and what kind of makes your heart race.

Hawley Well I like the idea of being confident about your passion within your passion because that feels- I don’t feel like an imposter, I feel like I can be confident about things that I’m curious about things that I’m interested about, and even if I might not believe in myself, fully showing that part of me might allow someone else to see something in me that I don’t see and create those opportunities that- that you’re talking about and you said you know if there’s not an opportunity to design it so I just I got it I ask you one more question about how do you do that?

Mix And, you know, just to kind of give you a little bit about my story, you know, when I started working on labor and delivery in the hospital and understanding because I enjoyed moms and babies, right? One of the happiest places in the hospital, but what I realized as I’m hearing some of the stories of, especially the young women who are coming in, you know, limited to no prenatal care, concerns about being discharged, where am I going to go? How am I going to take care of my baby? Are you going to be available to answer questions? That kind of led me to understanding, well, what is in place for moms, you know? What’s in place beforehand? What’s in place afterwards? So, that question drove me to seeking out opportunities so, you know, I went to work within a state Medicaid managed care organization because I wanted to understand who is in the community, you know, what- what- what are the constraints with insurance, you know? Because a lot of the young women were on Medicaid, soI worked with high-risk OB case management with the Medicaid managed care organization. At that point, you know, in a corporate position, again, you’re still trying to understand, wait a minute, there’s still rules that are- that need to be followed. Who’s making these rules and do they understand the needs of the people? That’s actually what drove me to federal work because I realized that a lot of the legislation, a lot of the policies, a lot of the rules that were put in place were set through the federal government and the different agencies that are reflected there, so that drove me into my work with HRSA. So, I think it, you know, making a way is really, you know, asking yourself the question and being curious and always being curious and following that curiosity and letting it kind of drive your positions, you know. I can tell the story now and it sounds like it was intentional, but it the positions were not intentional, you know, my interest- my desire- my curiosity was intentional, and when you align them right now it looks like, you know, I had a master plan back then. I had no master playing back then, you know? What I did know for myself is that I wanted to help others and I wanted to figure out what was in the way of them helping themselves, and so that’s kind of what drove me to my different positions and I think that’s why at no time you know when I graduated nursing school did I say I would like to be a captain United States Public Health Service. A, I didn’t even know that the Corps existed, you know, but this is where my journey has taken me, and if I had to do it again I’d probably still end up here.

Hawley Wow, that’s wonderful, and certainly, you know, how your life has unfolded in your- your great career, it just kind of shows that, you know, that could be greater than what you may be thinking about yourself or even understanding about the situation and that. I just read a book about designing your- your life and how it can be really stressful for people. What am I going to be when I grow up? And you’re in college, what am I going to be when I grow up? But really, as long as you’re moving in the right direction, and- the- your use of the word, curiosity, and following your passion can kind of keep you moving in the right direction, which each of those paths for you have led you to today. So- and- I’m really thrilled that it also led you to this time for us to be together, so thank you so much for your time and your insights and your- your extra plug for diversity. Thank you very much, we need to really think about these issues to help us move the work of public health forward.

Mix Absolutely, thank you so much I appreciate it.

Hawley Thank you so much for joining us today, we hope that you’ve gained a lot of insights from our interview and will tune in next time for a future leadership session.

Laurie Walkner Thank you for joining us today. Special thanks to our guests, Shirley Orr, executive director of the Association for Public Health Nurses, Suzanne Hawley, Roger Hileman, Melissa Richlen, Hannah Shultz, and Laurie Walkner.

Funding for this webinar is provided by the Health Resources and Services Administration. Please see the podcast notes for an evaluation and transcript.

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