Blog Posts for Oluwadamilola Fayanju, MD, MA, MPHS

 
Disparities in Cancer Research After COVID-19: Charting the Course from Inspiration to Intervention

When I open my eyes in the morning, hours before my family wakes up, I need a few minutes to collect my bearings. The question that flits across my mind is not whether I have to work today, but where.

Selective focus photograph of a brass pocket compass with lid open, set on rocky ground, with the sun rising in the background. Image credit: Dunamis Church via Unsplash

Will I need to go to the hospital? And if I stay home, where in my house should I settle down to work? Specifically, where am I least likely to be interrupted by my children (while still being available to mediate an argument or tend to a scrape), or to find myself having a virtual meeting at the same time that my husband is having one?

The truth is that I, like most people in academic medicine, do some kind of work every day of the week including weekends, whether that’s closing a patient’s chart, or writing a grant submission, or reviewing a manuscript. Computers, broadband internet, and VPN connections have liberated work from the workplace while imprisoning us within a 24-7 work culture, one that allows us to access electronic health records and medical journals from home and after hours—a very mixed blessing that I’ve written about before. The line between work and life has been fudged and blurred out of existence for most of us in medicine for years, but now this borderless, imbalanced approach has become the norm for the rest of the world, thanks to the COVID-19 pandemic...Read more


 

 
Introducing a Two-Part Series

May 9, 2020

Oluwadamilola "Lola" Fayanju, MD, MA, MPHS
Associate Director for Disparities and Value in Healthcare

A woman, photographed over her shoulder, spreads out a road map on the dashboard of a car. Image credit: Hannah Nelson via Pexels

“Are we there yet?”

A question both expected and dreaded by parents everywhere. Usually asked about 10 minutes into a long drive or flight, it not only reflects our children’s impatience but also their ignorance (innocence?) about time and space, about what it takes, in minutes and money and movement, to get from where we are to where we need to be.

But this question is more challenging to answer when you’re unsure of where your starting point is and what your destination should look like. This is the situation in which we now find ourselves with the global COVID-19 pandemic.

Here in North Carolina, we are believed to be just past “the surge,” i.e., the anticipated peak in cases where the balance between clinical need and clinical resources can potentially be upended, as we have seen at various sites across the country and around the world. For a variety of reasons including effective government and institutional leadership across the state, the surge in North Carolina does not appear to have been as severe as in other parts of the country, and the Duke University Health System (DUHS) is now taking its first tentative steps into the post-pandemic future...Read more


August 21, 2019

Oluwadamilola "Lola" Fayanju, MD, MA, MPHS
Associate Director for Disparities and Value in Healthcare

strong-mom

For various reasons, I spent 5 days in the hospital recovering from the birth of my first child, who is now 8. He was then much as he is now: precocious, bright-eyed, and nearly always hungry. He took to nursing like he was born to do it (which, of course, he was), and I was proud and happy that he latched within minutes of being born.

But after 21 hours of natural labor followed by an urgent C-section, I was already exhausted by the time he arrived. And soon I felt like my body literally couldn’t keep up with my child. The euphoria I felt as a new mom quickly eroded after 3 sleepless nights of painfully climbing in and out of my hospital bed every few minutes to nurse. Breastfeeding was painful, and as my ravenous child began to exact a fairly severe toll on my body, even the in-house lactation consultant couldn’t help but stare with barely concealed horror at the corporeal damage I was sustaining. Despite having had every intention to breastfeed for at least 1 year, I soon began to question whether this whole breastfeeding thing was going to work.

Eventually, with the help of the lactation consultant, various creams, and a little supplemental formula, my son and I hit our stride around day 10. I was lucky enough to be able to nurse each of my sons for over a year, and I am grateful for having been able to reach my personal breastfeeding goal. But as a recent survey of US physician mothers demonstrated, only 28% of my fellow doctor moms can say the same...Read more


[Originally published in Duke Magazine, August 2019 Special Issue]

August 7, 2019

Oluwadamilola "Lola" Fayanju, MD, MA, MPHS
Associate Director for Disparities and Value in Healthcare

My boys have dark brown curls and mischievous smiles. They speak with clarity and confidence. They move with boundless energy but also with unexpected grace. They enjoy playing with their lovies, reading with their daddy, and dancing with me, their mommy. They were born in St. Louis, but their great-grandparents were born in Africa, Asia, and Europe. They are six and eight. They represent the best of America. And I am scared for their future.

I am a surgeon and health-services researcher who studies disparities in breast cancer. I am interested in the potentially modifiable factors that contribute to ethnic and racial inequities, including how well or how poorly our patients feel (e.g., psychological distress) and how well or how poorly we clinicians treat them (e.g., implicit bias). Black women are less likely to get breast cancer than white women but are also more likely to die from it. Black women are more likely to be diagnosed with an aggressive variant of the disease known as triple-negative breast cancer.

These disparities reflect a messy web of ancestry and access, biology and bias that belies the social constructs of race we use to organize and categorize the people around us...Read more


June 27, 2019

Heart Balloon

Oluwadamilola "Lola" Fayanju, MD, MA, MPHS
Associate Director for Disparities and Value in Healthcare

The other day, after running as fast as he could around our yard, one of my sons ran up to me, grabbed my hand, and placed it on his chest. “See?” he said, “I can control how fast my heart beats!” I paused to position my fingers in just the right spot so I could feel his bounding, racing heart. And I paused again to reflect on the power of that amazing muscle, which – for most of us – works continuously from birth to death without pause.

Yet over the course of that journey from first beat to last, our hearts diverge widely in form and function and fitness, often (but not always) mirroring at its end the trials and troubles of the person whose life it powered. These idiosyncrasies are the byproducts of many things, including the genes we inherit from our parents (hypertrophic cardiomyopathy), the infections we pass among ourselves (viral myocarditis), the food we put into our bodies (coronary artery disease), and the babies we push out of them (peripartum cardiomyopathy).

Paradoxes of the Heart

As with many aspects of health, demography exerts an unfortunate but significant influence on destiny and, concomitantly, on disparities among patients with heart conditions. But with at least two of these conditions – atrial fibrillation and aortic stenosis – the connections between race/ethnicity, clinical risk factors, and disparities in treatment and outcome are so complex that the term “paradoxical” is frequently used to describe them...Read more


Desert highway to horizon

May 15, 2019

Oluwadamilola "Lola" Fayanju, MD, MA, MPHS
Associate Director for Disparities and Value in Healthcare

When I finished my surgical training, I promised my skeptical husband that we had finally reached the promised land of “being an attending.” No more 80- to 100-hour work weeks! No more falling asleep after sitting still for 10 minutes! No longer would I be the wife and mother who missed or was late to everything. And, when I was around, I wouldn’t be the exhausted shadow of myself that usually came home in the evening, having gifted my best self to the patients I cared for that day. Two-day weekends and non-assigned vacations were back, and so was I.

Of course, my husband was right to be skeptical. Not 3 months into my first job after completing my fellowship, I was pulling an all-nighter, realizing that the only way to close my clinic notes AND write the grant that was almost due AND see my children while they were awake was to work all night. Of course, the next day–a Saturday full of soccer and sunshine and stories–I WAS awake and physically with them, but I also had a fierce migraine that further frayed the ragged edges of my sleep-deprived mood. That night, I passed out in the middle of reading bedtime stories, and my kids again questioned whether I even knew how to read, as my tired mouth spouted gibberish that bore no resemblance to the words on the page. I don’t even remember falling asleep, but I woke up a few hours later with the kids in bed, the lights still on, and my face stuck to the book, now unable to get back to sleep.

So much for the Promised Land...Read more


Pig-and-fence.jpg

April 8, 2019

Oluwadamilola "Lola" Fayanju, MD, MA, MPHS
Associate Director for Disparities and Value in Healthcare

To do good work.

It’s a goal that seems both lofty and concrete, broad but focused. It’s the central tenet of both my personal and professional lives—and it’s why I’ve committed my career to improving the equity and efficacy with which healthcare is delivered, both to the patients I treat as a surgical oncologist and through my research on disparities and value in medicine.

I’m thrilled to be joining the leadership team at Duke Forge, where I hope to harness the rising tide of data science to lift all boats. Along the way, I also want to highlight and celebrate the remarkable work of researchers across Duke who are using the power of big data to address a wide variety of health disparities.

When I sat down to think of a topic for my first monthly blog for the Forge, the work of two of my colleagues in the Department of Surgery immediately came to mind...Read more