Pathways Voices: Episode 7

Maddie Albanese and DeeSoul Carson:

From the Center for Faculty Advancement at New York University.

Group:

Are we there yet? Are we there yet? Are we there yet?

DeeSoul Carson:

I’m DeeSoul Carson.

Maddie Albanese:

I’m Maddie Albanese.

DeeSoul Carson:

Faculty development is at the core of what we do.

Maddie Albanese:

Our programs are devoted to faculty support and development.

DeeSoul Carson:

From recruitment to career advancement…

Maddie Albanese and DeeSoul Carson:

… throughout the faculty life cycle.

Maddie Albanese:

We are also creating pathways for a younger generation of academic scholars, researchers…

Maddie Albanese and DeeSoul Carson:

… and future professionals.

DeeSoul Carson:

Are we there yet? Are we there yet?

Maddie Albanese:

There are only beginnings.

DeeSoul Carson:

How do you get there?

Maddie Albanese:

Who paved your way? Your path?

DeeSoul Carson:

How did you get here?

Maddie Albanese:

Who brought you along and held your hands?

DeeSoul Carson:

How do you get anywhere?

Maddie Albanese:

Whose shoulders are you standing on today?

DeeSoul Carson:

Who paved your way? Whose shoulders are you standing on? Who brought you along and held your hand?

Maddie Albanese:

Are we there yet? How do you get there? How do you get there?

DeeSoul Carson:

How do you get there?

Maddie Albanese:

How do you get there?

Maddie Albanese and DeeSoul Carson:

There are only beginnings.

Tina Sadarangani:

The then dean of NYU, the College of Nursing, named Terry Fulmer. Terry Fulmer had a PhD, and she was a nurse who was focused on improving geriatric care. And my mother-in-law said I had the most interesting interview with her because I didn’t know you could do a PhD in nursing. And this woman has done incredible things.

She’s shaping policy. She’s shaping health care, and she’s doing it for older adults. And I knew that I loved older adults from the start. That’s actually what made me choose nursing as a profession because I realized that so much of the care that people benefit from, particularly in later life and especially at the end of life, is nurse-led care and nurse-driven care.

So, I actually did come into nursing school very passionate about it. But I was fortunate because I had been introduced to people like Terry who are doing these amazing things, and it showed me the power and potential of nursing.

My name is Tina Sadarangani, and I’m a tenure track assistant professor at the NYU Rory Meyers College of Nursing.

I’m the child of two physicians. My parents came to this country in the 1970s with the immigrant dream of making it from India. Two years into their time here, my mother actually got pregnant with my older sister. My mother is a practicing obstetrician gynecologist, and this is in an era where there was no maternity leave. Her maternity leave was two weeks of vacation.

When she had my sister, my grandparents came from India, and they had come for what they thought was going to be a two-week vacation. And when they took one look at my parents’ life and the fact that my poor mother and my father, who was also a doctor, was on call every other night, they took one look at their lives and they said, you guys are never going to be able to handle this. We’re staying.

So, my grandparents, who were approaching 60, the second half of their lives, basically came here for a two-week vacation and decided to stay forever. And that was the luckiest, best thing that ever happened to my parents and to me. They came and they had my sister. Then my brother was born. And then by the time I was the third child was born, my parents decided, number one, to move to the suburbs and number two, to call in my other grandmother to come live with them, because with three kids they needed reinforcements. And we were so lucky to have these grandparents around because they really enabled my parents to work. My mother and father were very busy physicians, which meant I spent much of my time growing up with these grandmas.

And one thing my parents always told me growing up was that when you take the Hippocratic Oath to become a physician, you never, ever let your kids enter into health care because the system was so broken. I spent many years believing in that. And so, when I went to college, I became an anthropology major because I was really interested in studying different cultures and diverse populations.

As I went through college. In my last year, I learned for the first time, despite having these parents, that people were living longer in this country, but not necessarily better, and that there was a growing population of people like my grandmothers who were coming to this country in later life as part of our country’s immigration policies. This really inspired me to want to do more in this field.

And as someone who went to college in Washington, D.C., I really was interested in policy and I learned that the people who are making health care policy in this country, most of them have no idea what it means to treat a patient and what patients actually need. And so that made me want to change. And I understood why my parents felt the system was so broken.

So, I spent the last two years of college exploring different aspects of health care and growing up when my mother would take me on Take Your Daughter to Work Day. We would go through the hospital and there was a floor on the 10th floor of the hospital, which is a hospice unit, which is the end-of-life care unit, and it was the most beautiful unit, and we would only see it when the elevator doors were closing.

And I would ask my mother what is that place? It looks so beautiful. And my mother, who is someone who brings babies into this world at the start of their lives, looked at me and said, No one’s going there. Like most physicians, end-of-life really was not something she had been trained to to deal with. And so that made me, of course, more fascinated than ever in it.

And so, I became really interested in the health of older adults, particularly how we deliver end-of-life care in this country. When I started as a nurse practitioner, I actually came to NYU to do my bachelor’s in nursing as a second degree. I then went on to the University of Pennsylvania and became an adult and geriatric nurse practitioner.

In my early years of becoming a nurse practitioner. I worked in a federally qualified health center where many of my patients, I noticed, were older immigrants like my grandmothers. So, they would come in and they would ask to only be seen while their grandchildren were in school. They would have difficulty navigating the bus fare and many of them would come in with high blood pressure or diabetes conditions they didn’t know they had.

And so, they were in this very precarious place in life. They had responsibilities to their family and grandchildren. You know, I started becoming very interested in their health care needs. And that’s what prompted me to do a PhD here at the NYU Rory Meyers College of Nursing, where I studied the health of older immigrants. And I realized that one of the biggest factors in their care was that many of them were uninsured due to Medicaid waiting periods that limit them and prohibit them from getting public health insurance in their first five years of residency in many states.

So, I wanted to continue to do more, and that is what got me to understanding that while the insurance was critical, they also had faced language barriers. They needed transportation. They needed proper nutrition. And their families, who had brought them here, like my parents, they weren’t the end all be all. Unlike all of us, they never had the opportunity to go to work here to go to school. Many of them were lonely, isolated, and bored, and it made me reflect on my own grandparents’ journey here, my grandmother’s. It was inspired during the course of the provost postdoctoral fellowship, which I was fortunate to do here at NYU, to be able to take the money they actually gave me as part of my stipend, that very first semester, and go to a conference to explore these adult day centers.

Because what I had learned in my own family history was that when I went off to college at 18, those grandmas that came here to take care of me were bored with nothing to do, and nobody was home and they had no one to talk to. They didn’t drive. They barely spoke English. And so, one of my grandmothers started going to an adult daycare center, which changed her life.

And she was nervous at first, but she realized the center was full of people who spoke her language, other grandparents who would come, who shared her story, and other people from different cultures. So, I saw the joy that she had in that experience, how she connects with these people. And it gave her a reason to get up and go somewhere.

How they supported her with her health needs and give much needed respite to my parents, who were also caring for her. And that made me use the postdoctoral fellowship to look at these centers almost anthropologically and from a nursing perspective. So, I used the funds that they gave me, and I didn’t go to some wonky academic conference. I went to a conference of the National Adult Day Services Association. And I met all these people who were running these centers for people like my grandmothers, where they had bilingual staff, and the food was in line with their cultural preferences. The people, like my grandmother who attended, were co-creating. They were allowed to opine on the activities they did and all the different things.

It made me so excited, and it made me realize that all the things I know about successful aging, and keeping people aging at home and in their communities where they want to be, rests not just families, but the broader community, on neighborhoods, having an extended social network. And I became fascinated with these programs. And so, my postdoctoral fellowship allowed me to understand the vital role that these centers play in helping older adults age successfully, like my grandparents, particularly diverse older adults and people who come from other countries, because they provide that continuity. They respect their culture, they include all those things, and they give them opportunities to socialize and productively engage that they may have never had.

And so now, as a tenure track assistant professor following the fellowship, I’ve been allowed to continue exploring this. And the National Institutes of Health have fortunately funded my research in this area, particularly with such a growing population of people with dementia and cognitive impairment, I’m now focused as a researcher on ways to connect the care that these centers are providing with broader health care. So, most of them think of day centers as dancing and dominoes for older adults. But I’m looking to change that and make people realize that they’re actually incredible platforms for chronic disease management that do incredible things for hard-to-reach diverse populations who benefit from them most.

And I’m actually, to that effect, building a mobile application to help connect the care provided in centers with caregivers, family caregivers and the broader health care team. And it’s a tool to really support caregivers who deserve and need much more support because not every caregiver is a nurse and or doctor, and they haven’t been trained for this. And they deserve all the supports to know what information is most important, what signs to look for, and to have that information in the palm of their hand when they need it.

Maddie Albanese:

Are we there yet?

DeeSoul Carson:

We’ll see you next time.