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Dr. Selwyn Vickers: Hi, and welcome to The Checkup podcast. My name is Selwyn Vickers. I'm the Senior Vice President of Medicine and Dean at the University of Alabama at Birmingham. On The Checkup, we introduce you to people who are powering science and medicine at UAB and around the globe. We discuss the broader issues of healthcare including clinical outcomes, disparities, research as well as our overall growth of our faculty and the maturation of our school. We hopefully will provide tremendous insight to where healthcare is going and the opportunities UAB is providing for the care for our patients and leading in research in this part of the country. So thank you for listening to The Checkup. We'll dive right now into our next episode.

I want to maybe get started by giving you a chance to introduce yourself to the audience and maybe including in that your path to UAB, but also your path to having interest in wellness.

Irfan Asif: Yeah. Dr. Vickers, thank you. It's very nice to be on this podcast and thank you for inviting me. For those of you that don't know me, my name is Irfan Asif. I go by Irfan. I was born in Cincinnati, Ohio, played soccer at Xavier University, and then went to med school at the University of Cincinnati. Really enjoyed my time there and have always been interested in sports medicine. But as I was preparing for a career in sports medicine, I was trying to get my resume ready for residency and thought initially I would go into something like orthopedic surgery. So folks told me, "Hey, you should cover some sporting events, do some research." And so I did those different things.

And as a third-year medical student, we have something called the Flying Pig Marathon in Cincinnati. So I was a medical student. They said, "Stand at the finish line. And I just want you to tell us if someone's sick or not sick. If they're sick, bring them over to the medical tent. If they're not, make sure they don't clog the finish line. I said, "I can do this." So about the two-hour mark, which most people are finishing the half marathon, 45-year-old gentleman comes in, eyes are deathly pale, they roll back. He falls face first in front of me. Obviously, he's sick. I run to him, I pick him up. Another medical student sees me, we run them to the tent and we start doing CPR. Lines, tubes, defibrillation, this guy doesn't make it. Forty-five-year-old, really healthy, three kids, dies of sudden cardiac arrest.

And it was at that moment that I decided, "You know what? I'm really going to devote myself to trying to prevent sudden cardiac death in individuals, so I can prevent these tragedies from happening." So I decided to go instead of orthopedics into family medicine, dealing with the whole body, dealing with sports medicine that encompasses the heart and the head, also sprains, strains, but, you know, skin problems in athletes, diabetes in athletes. And University of Washington is really known for primary care, but also their sports medicine fellowship has a special focus on preventing heart problems in athletes. So I've been doing research in prevention of sudden cardiac death in athletes since then. What kills people? How often can you screen for problems? Can you resuscitate people when they have injuries? What are the psychological implications when somebody is diagnosed with the disease?

And then I went from there to the University of Tennessee and continued that research. And it was when I made the shift from University of Tennessee to Greenville, South Carolina, where I was Vice Chair of Academics and Research that I thought, "You know what? This concept of trying to prevent heart problems in athletes, can we use those same principles to prevent heart problems in everyone?" And what are those foundational principles that you can do? You can ask people to exercise, to eat healthy, to de-stress, to sleep well. And so we began building wellness programs in Greenville. One of the major ones was called Exercise Is Medicine where we partnered with YMCAs across the communities and in Greenville and other parts of South Carolina.

And then I came here three years ago to be the Chair of the Department of Family and Community Medicine and then, most recently, the Associate Dean for Primary Care and Rural Health. And I've tried to continue to implement those wellness concepts throughout my career, and hopefully bring them to Birmingham and Alabama and can continue to do this in the future.

Dr. Selwyn Vickers: Good. That's a great story and journey to your career and role as a leader. And we're glad to have you at UAB and at the School of Medicine. So Irf, August is National Wellness Month. And I want us to talk about wellness from a number of perspectives. But first, I want in part to talk about how wellness related to the individual and community health stay important. Obviously, as the chair of the Department of Family Medicine and Community Medicine, that's got to be a significant part of who you are as a leader in your department. Let's think about individual and community wellness first. And what do you think about wellness as it relates to an individual? What are the factors that are important?

Irfan Asif: Yeah, that's a great question. When I think of wellness, I think about wellness for the person. I think about wellness for teams. And then I think about wellness for communities. And I think some of the core concepts for me at the heart of wellness include trying to get people to be physically active, to eat healthy, to de-stress, to sleep well. But at the same time, if you don't have good access to any of those or good access to care, good access to just taking care of your own families, you can't get to some of those other things of getting people to exercise. So building safe communities, building healthy populations, that's part of what's at the heart of our Department of Family and Community Medicine.

Dr. Selwyn Vickers: Outstanding. When you think about it from the point of view of prevention, how does prevention tie into wellness, and how they're different and how are they fundamentally linked?

Irfan Asif: Yeah, that's a great question. So when we think about disease prevention, if you think about some of the common diseases that we have, I think about high blood pressure, I think about high cholesterol, diabetes. In med school, we're often taught to think of the medicine that might be able to combat the disease process. But if you look at the top box in an algorithm just below the disease, the first line treatment for all of these diseases is lifestyle measures. Again, fundamentally, how do we get people to move. If they can't exercise, if they can't do the things that you and I might think about, there are ways to just take more steps in a day or to make some healthy decisions that might be able to impact your overall health. So those are the things when I think about prevention, again preventing some of the chronic conditions. And then when you tie in primary care, we want to also think about how we prevent diseases through just routine screening, so breast cancer, colon cancer, prostate cancer, those things are also a big part of what we do in addition to the wellness concepts.

Dr. Selwyn Vickers: Great to hear. So as a researcher interested in health disparities, as one of my focuses, how do you envision taking the concepts of wellness and prevention and impacting chronic disease. If you look at a state like Alabama, we have a poor performance in almost every area of chronic disease. And everything in my bone tells me it's something to do, not only with lifestyle, which includes diet as well as access to care. How might you see an intervention around wellness and prevention through your department or others being able to impact a culture or community to pursue wellness?

Irfan Asif: That's a great question, Selwyn. So when you think about this, the keyword that you said there is culture. We have to be able to impact the culture. You and I might think about exercise or nutrition in one way, but we need to think about the populations that we're caring for and they need to be at the table when we're making these interventions. So I think we have to get out into the communities. I think we have to think about how to bring them to the table and we need to ask them if this is something that's going to make you healthy, how can we do this in your group, in your particular setting? So that might be where we think about exercise. And in a culture, for example there's a group that we work with called Hip Hop Public Health. And some of the culture is tying physical activity to music. And for some cultures, that's a way to get people to move, but that may not have been a way that I might have traditionally thought in the past.

So the culture is the most important thing when I think about doing innovation. And I'd love to be a part of what UAB has to offer. As you mentioned, health disparities is a key piece, but precision medicine, thinking about how we can tie in genomics. I think a big piece to doing some of these projects is also not having people always need to come here for the interventions, but to think about how we can bring those things out into the communities.

So partnering with Mona Fouad on things such as her Live HealthSmart Program, where we have mobile wellness vans and we go out into the community. Selma, for example, has worked with Mona on the Dock On The Spot Program. We also partnered with their community on an Exercise Is Medicine intervention using some of their local exercise facilities. So we can design these programs, but it has to do with culture and also taking these interventions out into the communities.

Dr. Selwyn Vickers: That's really important. Irf, have you seen any particular cultures that you might say be good for us to model by virtue of what they do in their lifestyles?

Irfan Asif: So that's a great question. I think some of the places that are doing this well, and San Francisco actually is the place where we learned about Hip Hop Public Health. So I think taking some of those ideas and bringing them to to our state, to our communities and to see if they would work. Again, some of the principles that we mentioned came from a meeting that we had with them in April. So I'm hoping to continue to learn from other states, other cities, other populations, and to see if we can bring those ideas back here.

Dr. Selwyn Vickers: Gotcha. Irf, what do you do for wellness?

Irfan Asif: So a former soccer player, I still play soccer twice a week. I play racquetball. I like to run. I like to lift weights. And so working out is a big part of what we do. My family, my wife is the same way. And we take our kids out on the weekends. And that's part of the reason that we came here to Birmingham. We love being outside. I love that the weather is warm all year round. And to me, it's a great place to be. I'm not a cold weather guy, so it's easy to do outdoor activity, particularly when you think about COVID. You know, if some of the team sports are shut down, you can still get outside whether it's you or your family when there's nice weather. And I don't know, Selwyn, if there's something that you like to do for your own personal wellness.

Dr. Selwyn Vickers: Yeah. So I enjoy both spending time with family. I love deep sea fishing. I love just seeing new places, even if they're local. So, it's getting away. I like, like many people, just being around water, particularly if it's the ocean, those are very common. But I would say being with family and really relaxing as well as given the opportunity to do deep sea fishing, which I can't do enough.

Irfan Asif: I've seen you out on the Lakeshore Trail on the bike and heard some neat things about you on the volleyball court.

Dr. Selwyn Vickers: That's right.

Irfan Asif: Also, I think you've got a personal trainer, so you are definitely invested in health and wellness. Well, the bike is another thing. I enjoy that. I could ride for miles and I enjoy it, it's quite relaxing, even though you may not get your heart rate up as fast as you like. I certainly liked the endurance part of it.

Dr. Selwyn Vickers: So Irf, in the context of where we are now with COVID, how do you see wellness being a significant factor in how people manage the stress of COVID as well as the resurgence that we're seeing in Alabama? There are just multiple factors that are infecting the workforce, including physicians and nurses and caregivers who now are feeling burnout at a level like they've never felt before. How does wellness fit into that? And what aspects of wellness can impact that to give us resilience?

Irfan Asif: It's a great question, Selwyn. So for me, when I think of the different aspects of wellness, mental health is really the biggest piece that's been impacted for me during COVID. I remember sort of reflecting when COVID first hit and thinking I can't do the things that I normally do. I can't go out and play soccer or be on teams. But again, as individuals, we are social by nature. And so how can we recreate those experiences? And so for me, trying to do Zoom calls with some of my friends. Each Friday night, we think about getting together at 9 o'clock from across the country, again, because I haven't been able to see them in over two years with some of the COVID pandemic. So being able to build those relationships, even if we can't see each other in person. And then for me, I think about resilience building through some mindfulness practices.

And one of the ones that I think about the most is called Three Good Things. What I do each evening is with Three Good Things is to try to reflect on three things that either impacted me or something where I had an impact on someone else, maybe made them smile, and I try to write those down in a journal. So some of these resilience practices, we actually in our department have a Director of Leadership and Professional Development, Michael Wiederman, and he's an expert in resilience. And this is where I've learned some of these practices from. And he's been working quite a bit with David Rogers and Nisha Patel on their Take 5 Tuesdays. He's been helping with some of the articles on just building teams. And sometimes with building teams in our department, we're actually building a quite a new team. So thinking about how you have difficult conversations with people, especially in an era where you're not seeing everyone as much, you're writing emails quite a bit. Sometimes that can lead to different personalities showing themselves. And I think trying to find ways to have those conversations, even if it is through Zoom so that we can get along and all work together. Because as you said, the mental health and wellness of people, the stress levels are at an all time high. So we really need to be thoughtful about how we work through any issues that we have.

Dr. Selwyn Vickers: I appreciate that. That's very thoughtful to hear, but it sounds like in, number one, when people need to interact with other individuals they care about and love, even meet new people, but they need to avoid isolation. It sounds like in addition, it's maybe cathartic and helpful to write down your thoughts to be able to write and journal things you've experienced. And then, the third highlight is that reflect on what's been positive. Even though there's a lot of stuff that can go wrong, give yourself some space to appreciate the good things that may have occurred, that may not just step out if you don't take the time to think about what they they were.

Irfan Asif: Exactly. And again, hopefully being an Alabama, there's a way to still be outside and, you know, with social distancing in place to still see each other.

Dr. Selwyn Vickers: You began to talk about it. Tell me about some of this effort in your department. You mentioned that you have an individual who has a skill set in this area, and you have programs of interest related to not only your department and community wellness. Tell me what that looks like.

Irfan Asif: Yeah. So as we recruit individuals into our department, this is actually fundamental to the questions that we ask. We ask quite a bit about wellness, resilience, and emotional intelligence within the questions where we screen people for positions within our department. Over the past couple of years, we've worked on developing different leadership programs in our department and that's led through Michael Wiederman and the Office of Leadership and Professional Development.

But aside from that, we've created an Office of Identity, Inclusion and Collective Conscience. That's led by Brandy Shah. And some of the ways that she works in wellness or promotes wellness within our department is to create a calendar of diversity that she shares across the department. She's facilitated a book club where we celebrate the diversity within our team. And that's another way that we build bridges within the team that we have. In our department, we very much focus on lifestyle. Again, exercise, nutrition, mental health, sleep.

So we have clinical programs, one of which we launched this past year called Fitness, Lifestyle and Optimum Wellness for patients. But that team of people, Caroline Cohen is part of that team as a registered dietician, Kaylee Crockett as a psychologist. We have some sports medicine folks, Kim Fagan, Ian McKeag. All of those individuals work to take care of the patients that we serve, but they also work to take care of our department. So you'll see in our communications led by Erin Slay-Wilson, that each month, we send out a social media programs that can help our communities as well as our departments.

We also have a program that we did this past year during COVID called Scenes From Quarantine, where we actually asked people each week to send in photos from quarantine. And the winners from the photo contest, we actually bought them dinner. So we tried to make it fun to be a part of our department. And again, we have a really great team, but it all starts with the selection process when you interview with us.

Dr. Selwyn Vickers: That's great to hear. Irf, maybe I want you to comment on this program that I've heard a little bit about, but it seems that it has a connection with trying to deal with the medically underserved, who often have major wellness and prevention issues called Cure. Can you describe that?

Irfan Asif: Yeah. We're excited about the Cure Program. The Cure Program is actually a HRSA-funded program that's in our department and the goal of the program is to actually increase the number of students who go into family medicine and primary care, both the number, but also the quality of students.

So we're designing three different facets to this program. We're looking for pipeline programming to increase the number of students who would want to enter medical school with a flavor of maybe thinking about primary care. We have medical student programming, and then we have faculty development, so trying to teach the teachers who are going to be part of this Cure Program.

Most of what we spend our time on this first year is really piloting an urban underserved program. And we've had eight students in the inaugural class for the urban underserved pathway. We were fortunate in this program to actually award $20,000 scholarships to the students of this program. And I think they've found this to be an extremely beneficial complement to the medical school education that they're getting here at UAB.

They start working in the clinic on day one. So within the first year of medical school, they are working in the clinic. They work in the clinic even more in between first and second year. And then they do more clinical programming in the second year, leading into the third and fourth year. So I'm excited to see in this pilot if this actually increases the clinical acumen of the students that we come out with the Cure Program.

Additionally, one of the unique aspects of the program is that each student gets a 10-patient panel. And the 10-patient panel, all of the patients come from underserved backgrounds. We choose them from pediatric ages, middle age, all the way to the geriatric population. So it's a diverse population and the students are going to care for them for all four years of their medical school training. They'll be asked to talk about a screening program, so what are the colon cancer screening rates? What are the breast cancer screening rates? What are the vaccination rates? They'll also be tasked with being a health coach for these underserved patients. So they're going to pick one aspect. Let's think about quitting smoking. Let's talk about exercising some more. Let's talk about how to improve stress in your life.

And so these 10 patients are going to teach the students about themselves, about patients, about communities about the healthcare system. And again, I think this is truly unique to UAB as I'm not seeing this across the country. And if you put the 10 patients together from all the students, you'll end up with a pretty unique population that you can study down the road.

Dr. Selwyn Vickers: No, I think it's an impressive program. I assume you want to see more people go into family medicine, too.

Irfan Asif: Correct. Family medicine and primary care. Certainly, family medicine is one way to get into primary care, but internal medicine, pediatrics, and then there's some people, even in the OB GYN and psychiatry spaces that have primary care DNA that I'll look to in the future too.

Dr. Selwyn Vickers: Irf, are there any other critical components that support good mental health for all of us during this difficult time, or particularly for our caregivers who are facing challenges on a daily basis?

Irfan Asif: No. It's a great question. I think one thing that we haven't talked about, but we've alluded to is just giving back to the communities that we live in. I think we've talked a lot about personal wellness and the wellness of teams, but how do we give back to the communities that we serve? And in our department, we volunteer in different spaces, whether that be Be A Blessing Birmingham; some of our faculty being sports medicine volunteer, the Birmingham city school. We have faculty who take care of USA Wheelchair Rugby, which oftentimes when you think about disability, most people want to go to the USA Men's Basketball Team, for example. But we have teams here that maybe don't quite get the same care, but operate at that same level. And they've been super excited because they've never had anyone care for them and they're going to the Olympics too.

So to me, giving back to the communities, seeing a smile on someone else's face when they are going through what you just said, an extremely difficult time, I think that can help lift us in a time of COVID or in a time of need for all of us across the world.

Dr. Selwyn Vickers: It's great advice. And I really appreciate your thoughtfulness, the programs that you developed in your department and your perspective I think even on our whole state as an opportunity to improve health and wellness for all of our citizens. We are in great need of it now, but you'll need it even more as we get rid of and get out of this pandemic because some of the things that plague us are chronic and they won't go away. And yet we see early generations running to the same challenge of chronic disease because of lifestyle and because of a lack of a commitment to wellness both from the individual and from the community.

So thank you for participating in this podcast, and I'm excited to see that you are continually pushing forward with wellness for yourself, but also for the broader community. Thank you very much. And thanks for having me, Selwyn.

Irfan Asif: Absolutely.