David Quackenbush (Host): Hello and welcome to the Golden Valley Health Center's Golden Voices Podcast. Today, I have Dr. Ibraheem Al Shareef. He is a—well, he's multiple things for Golden Valley. He is a pediatrician, he is a regional medical director, and he is also leading up our exciting clinical trials that we'll talk about. Thank you for joining, Doctor.

Ibraheem Al Shareef, MD, FAAP: David, thank you for having me.

Host: So, as you know, because some of your colleagues have been on this podcast, this podcast is all about the journey. You have quite the story, as a lot of our clinical leaders do. But I wanted to talk about you, and I'm always curious when I talk to doctors about why doctors picked the specific specialty. And in your case, pediatrics is very specific, because as you know, with your colleagues, there are doctors that love treating kids, and there are doctors that want nothing to do with treating kids. And that's a career choice that people make along the way.

So, Doctor, let's start there. Can you just tell us about your—and maybe it was how you grew up and how you came up—but the journey it took to becoming a doctor and then your decisions to specifically become a pediatrician?

Ibraheem Al Shareef, MD, FAAP: Certainly. Speaking about how I wanted to do medicine in the first place, I think there are several factors going back to my early childhood. I grew up in a family where my father was a general practitioner, and in the era where general practitioners were a real precious commodity. So, he worked in the Gulf for 15 years before coming back to Lebanon, my home country. I also had a very prominent uncle who did psychiatry and neurology, a very prominent figure in Lebanon medically. I had another uncle who traveled to France to do dermatology. And I had several older cousins who went into medicine.

So, the setup and the environment was, there, like encouraging, although there was never any pressure. But there was already this atmosphere that, "Hey, there's a pretty good potential that you're going to be a doctor someday." But I think the driver for my decision to go into medicine is the fact that my father had a stroke very early on, I would say in his early 40s, as soon as he came back from working on the Gulf—doctors are the worst patient's, right? So, he never paid attention to his blood pressure. And when the war broke in Lebanon, with all the pressure and stress, his blood pressure must have gone up to very high, dangerously high levels. And that resulted in a stroke, unfortunately, that left him hemiplegic. So, my memories of him as far as it goes back is for him being hemiparetic paralyzed, and I realized how much that affected him physically, but also emotionally, psychologically, and affected basically all the household, the entire household.

So, I did develop a sense of appreciation to health early on and the loss of health and that affects one's life and the lives of the loved ones around them. And I started thinking, like, what could have been done in order to prevent this? And as I grew older, the answer was prevention, preventive care. That was what was leading me into the field of medicine in the beginning and later on to pediatrics.

Host: So, I didn't realize—that's a tremendous background and that's why we like to talk about journeys, because, I mean, first, you had the family experience with all of your relatives and folks around you. You had a lot of medical professionals in your direct ecosystem, which is pretty profound. And then, your father, obviously being a doctor also, I mean, it was very impactful. I'm just curious. I think you said there wasn't any pressure, but I mean, you couldn't have not felt—well, let me ask, did you feel some kind of expectation to become a doctor being in that environment?

Ibraheem Al Shareef, MD, FAAP: Absolutely. I think expectation is the right word. And when you hear it so many times over so many years, it becomes sort of pressure. So, it's then upon you to either fight it or take it if you think there's a possibility. In all honesty, the expectation was there. But I enjoyed full autonomy choosing what I wanted to do for the rest of my life. And like I said, once I realized that prevention is key, I soon realized that prevention probably starts at a very young age, building the pyramid from the base up. That's why I went into medical school And then it's a little bit different in Lebanon where you have like commitment from day one until the six years. So, there's no pre-med. So once you're in, you're in.

Host: Let me pause you there, because that's interesting. I don't think folks necessarily realize the diversity in medical education around the globe. And, you know, at Golden Valley, we celebrate the diversity in our international medical graduates. So when you say there was commitment from day one, you enter university as a medical student?

Ibraheem Al Shareef, MD, FAAP: Correct.

Host: And then, where along the line do you have to decide your specialty?

Ibraheem Al Shareef, MD, FAAP: So, that comes in after those six years of medical school, followed by one year of rotating clinical internships. I can say that's rotating in the hospital, trying to get exposure to different specialties and trying to decide if you have not already decided what you want to do.

So at that point, within that seventh year is a time where you basically get to decide or you're comfortable to decide. And let me tell you, with the clinical rotations, you fairly quickly try figure to it out early on. But also, much more quicker, you realize what you definitely do not want to do.

And I do remember my first exposure to delivery when I was a medical student. I'm not going to go into details, you know, it's probably too memorable to share right now. But I realized immediately that this was not my calling. So, pediatrics stood out possibly, and in part because I had great pediatrician mentors. And also, I was always fascinated by the fact that the ability to diagnose a child who is not fully able to verbalize what they're feeling. And then, you rely on observation, you rely on the communication with the parent, to try to figure out what the diagnosis And the treatment is. So, that, to me, felt like some sort of diagnostic superpower. So if I go back again in time, I would probably make the same choice all over again.

Host: That's great that it worked out that way. So after your seven years of education and training in Lebanon, today, we're talking and you're sitting in Merced, how did you go from Lebanon to Merced?

Ibraheem Al Shareef, MD, FAAP: So, there were several stops along the way. After I was done with the seventh year, I applied to do residency in the American University of Beirut, which it's one of the top prestigious universities historically in the Middle East. They follow exactly the American training system. So, that got me exposed to even more expertise. A lot of American board-certified pediatricians and physicians in general. And the chairman actually was a world authority on pediatric neurology and epilepsy.

So after I finished residency, I decided to go into pediatric neurology, and I completed three years of pediatric neurology within the American University of Beirut. And at that time, until probably the last two years of those six years in total, I did not initially plan to leave Lebanon and come to the United States. But several things happened. My mother passed away a few months before my graduation from medical school, the worsening political situation in Lebanon.

So, there suddenly was this notion, new notion for me that, "Hey, you know, maybe the circumstances are now favorable to think about it." At that point, during my fellowship is where I met my wife right now and I can share the story of how we met. I think we shared it earlier, but I think I always like to share it. And then, we made a joint decision that is probably better for more stable future that we moved to the United States. And that wasn't an easy decision. It was a hard decision.

Host: Just curious, because you did so much education Lebanon and in the area, and you had such a profound family presence and expertise and professionalism in the medical profession in your home country, how did your family, how did your extended family think about you coming to the US to practice?

Ibraheem Al Shareef, MD, FAAP: Well, initially, they felt that there is a family member and a doctor whose departure is going to be a loss to the family and the family value and the community as well. But at the same time, what I was feeling is something that was really palpable that the country is not very stable right now. So, a lot of people were already traveling. But again, it wasn't an easy decision. But after weighing the pros and cons, sometimes we have to make that hard decision.

Host: Yeah, I think for healthcare professionals. That have worked in the United States system forever that, as you know, depends on international medical graduates at pretty much every level—doctors, nurses, and kind of all kinds of clinical provider level. I think we always think that professionals coming from other countries may not have any other choices—and this is probably our bias—or may think the US is the best healthcare delivery system that everyone should want to participate in. But I don't think we've talked much about what you just talked about—what are we leaving behind. And you have a family legacy of medical experts and professionals that have done great things in their home country.

So, I think that's an interesting piece to make sure we discuss, because I think there's always the instinct that there's the draw to the US, but people don't think necessarily about what folks are leaving in their home country. So, you've been at Golden Valley for quite some time now. You seem to really enjoy it. I think you and your family have settled in the environment. Tell me how finally landing in California in Merced and Golden Valley, tell me about that experience and tell me about why you continue to be with Golden Valley.

Ibraheem Al Shareef, MD, FAAP: So, the path to coming to the US was not exactly always smooth. I think one of my first challenges started even before I ever stepped foot here. I had a visa delay for eight months. And I was like six months or five months late to the program. And I'm grateful that the program did wait for me. And at the last minute, my visa was cleared. So, we were finally happy to be here. But that meant that we needed to arrive in December in upstate New York, which was something that we were not prepared physically or mentally for. And so, we were fascinated initially by the snow, right? And that fascination lasted for two weeks, before we realized that we need to shovel our driveway every day and not enjoy the real sunshine for, except for a couple of months of the year.

Being in a new culture and having to make new friends in your early 30s is not exactly something easy. But the time there wasn't enjoyable. I did end up doing two and a half years of residency taking into account my previous training that the American Board of Pediatrics allows. And I was also fortunate to do part of that as a chief resident. So, that was my first exposure to medical leadership there.

And then after that, in order to stay in the US, I needed to work in an underserved area. That's the J-visa requirement. So, I interviewed in few places. Golden Valley was the best place that I had that interview in. People were friendly. The first doctor I met here was Dr. Myers. So, we were still joke about that day.

And once I started here, I realized that this is something that I can relate to. In upstate New York, I cared for a lot of kids with different backgrounds, families of different backgrounds. But what resonated with me is the look and the smile on the faces of the parents who really struggled to have their kids seen and appropriately taken care of. I did see the same expression here and gratitude here while seeing the GVHC patients knowing what challenges they face and the ability to make their lives better. So, what initially might have been a a few years—we thought—the project extended. And here we are right now 10-1/2 years later.

Host: Yeah. I think a lot folks from other countries experience very similar dynamics with their patient populations. I hear that very, very often. I've never shoveled snow by the way. Nor do I desire to.

Ibraheem Al Shareef, MD, FAAP: Good for you.

Host: So, I mean obviously we've appreciated your longevity here and you've been a steadfast pediatrician for those 10 years. Most recently, you took on the challenge—and challenge is my word—and became regional medical director, as you know, it's a new challenge for you. And then, you graciously took on the role of leading our clinical trials work. I mean, at Golden Valley, we want to continue to advance and expand our services and our information and expertise and knowledge around our patients. That's why we do a lot work around medical education and university partnerships and trying to influence students that come through to become practitioners at health centers and at Golden Valley.

Clinical trials is new for us. I mean, I think the motivation behind getting involved with clinical trials is because many patient's that are from backgrounds like ours are and from the diversity of ethnicities and countries typically aren't involved or included in clinical trials. And I think that's very consistent, both what we try to do here. What is your interest in clinical trials? And what do you think that's going to do for Golden Valley as an organization?

Ibraheem Al Shareef, MD, FAAP: So, that's venture that we undertook under your leadership, David, I would say about a couple of years now between the first conversation and we are today. First and foremost, it serves two main purposes. First one is allowing exposure of novel medical advances to a population that has been historically underserved, not only medically, not only in direct patient care, but also in exposure to research, including possible treatments that might not be otherwise available. The research activities in general center around tertiary academic centers usually present in metropolitan areas and not necessarily rural towns in central California.

So, bringing this here for the benefit of our patients has been the main driver for it. And with that also comes a lot of responsibility and a lot of things that come with that designation, a lot of preparation that we need to do to make sure that we're doing the right thing, especially that we're a federally qualified health center who do not do research for a number of reasons, including the complexity of regulations and compliance. And so, it did take a lot of collaboration from a lot of departments. That also is a testament about GVHC's ability and teamwork.

And eventually, it serves also to elevate Golden Valley Health Center's status, not only as an organization that is providing quality medical care, but also as an innovative center that also incorporates state-of-the-art technologies and state-of-the-art medical advances to the benefit of our population. So, these were the two main purposes for taking on that venture. And I'm glad to see it coming through.

Host: Yeah, that's great. I see it as kind of pushing the organization to be a little more innovative and thoughtful about what we're doing. So yeah, I look forward to the results of that. What I like to do as we wrap up the podcast is ask the guests about their advice to folks that are thinking about healthcare. I didn't realize this before we had this conversation. You are—I mean, if I do the math right, what do you have? Twelve, 13 years of medical education and residency training? I mean, that's pretty significant. And now, you have 10 years experience here at Golden Valley.

Just as folks that are considering healthcare or considering working for a federally qualified health center in an underserved area, just what is your advice to them along their education and career paths?

Ibraheem Al Shareef, MD, FAAP: Sure. I would like to mention a few things if time allows, or if you don't mind, David. They're kind of related to each other. First, you need to do what you love and love what you do. If you don't, it's going to be very difficult for you personally and professionally. So, that's first and foremost.

My other advice is make sure that you take those tiny extra steps with each and every patient that you see with all patients, no exceptions. These go a long way, not only with how you perform, but also attest to your integrity as a human being, which is at the base of what doctors do.

I would also advise to be flexible and adaptive. It is really rare that things go on as we plan from the beginning, right? There are a lot of pivots. There are a lot of, you know, stuff that take you in this direction or this direction. A lot of that happened with me. But considering it as a blessing, not as a setback, I think is key to excelling or key to be happy and successful in anything that you do. There's a saying that life is what happens to you when you're planning other stuff, right? So, being adaptive and flexible and resilient is very important.

 Also, it is—within that context—never stop learning. I learned a lot in my 20s, learned a lot in my 30s and I'm learning a lot of things every day as well. It's a never-ending ending journey of learning. Every project, every conversation, every meeting is a potential opportunity to learn and a potential opportunity to do something better for your career and for the patients that you care for.

 And the last thing which means a lot to me is pay close attention to your life outside of work. Life is going to be busy all the time. It's never going to get better. So, make sure that you find, create some time, the very well deserved time for your support system, for the people who are close to you, whether it is spouse or partner, family, faith community, close circle of friends, all of these are extremely important. And, overall, they're a major part of what you are right now as a human being and how you're going to function on the personal and the professional level.

Host: I appreciate those thoughts and that's a phenomenal way to end. Thank you for joining us on the Golden Voices podcast. I appreciate your time. As we all know, you are ridiculously busy, not to mention you're also seeing patients regularly. So, thank you very much for joining. And I appreciate your time.

Ibraheem Al Shareef, MD, FAAP: Thank you, David. It's an honor to be here.