Ask Away! Blog Series featuring Dr. Al-Rousan

 

Welcome to our Ask Away! blog series, where we had the honor of chatting with Dr. Tala Al-Rousan, an inspiring epidemiologist and global health researcher. Originating from Jordan, Dr. Al-Rousan's journey, shaped by personal experiences and humanitarian work, has propelled her into the forefront of health equity advocacy. With a fervent commitment to understanding the health dynamics of marginalized communities, particularly refugees, her current groundbreaking hypertension self-management intervention study among Middle Eastern and East African refugees in San Diego highlights her dedication to addressing health disparities.

In this interview, Dr. Al-Rousan shares insights into the role of technology in her research, her passion for mentoring, and her vision for the future of immigrant and refugee health. Join us in exploring the transformative power of science and its potential to contribute to a healthier, more equitable world through the lens of Dr. Tala Al-Rousan's impactful work.

Can you share more about your journey and background that led you to focus on health equity and global health research, particularly with marginalized populations?
A: I spent my formative years in Jordan, a nation where one out of every three individuals is a refugee. My own parents were refugees from neighboring countries, and their experiences vividly exposed me to the profound impact of trauma resulting from forced displacement on their health. Having undergone medical training in Egypt and subsequently joining Doctors Without Borders to practice medicine in impoverished countries, my perspective on health transformed into a staunch belief that it is an inherent human right. As a first-generation immigrant now residing in the United States, I am consistently engaged in unraveling the complexities surrounding migration, encompassing diverse categories like refugees, asylum seekers, the undocumented, and immigrants. Alarmingly, the current global scenario indicates that one percent of the world's population is either refugees or forcibly displaced, marking the highest recorded number in history. Forecasts suggest an exponential increase in this figure due to climate change and a rise in violent conflicts, observable in new geographical areas such as Europe. Regrettably, refugees often become pawns in political negotiations, subjected to dehumanization, discrimination, and exclusion from health-focused research. This not only impedes progress in health equity but also hampers our collective readiness for a future where an even greater number of individuals may face displacement.

What inspired you to specialize in epidemiological research?
A: Epidemiology serves as the cornerstone of public health, and my decision to specialize in it was driven by the desire to acquire the necessary tools for comprehending the health dynamics of marginalized populations. During my academic journey, I pursued training in various realms of public health, including community health and health policy, alongside my master's degree and two postdoctoral fellowship positions. This diverse training equips me with a comprehensive skill set, enabling the design of research studies and the meaningful engagement of minority populations that have historically been distrustful of researchers. Through my work, I tackle significant questions related to causal relationships, providing vital answers that furnish evidence for organizations, policymakers, and key stakeholders. This evidence, in turn, plays a pivotal role in advancing efforts to alleviate health disparities. Each day, I continue to learn as I navigate unique and wonderful settings and populations, recognizing the richness of diversity in every context.

We understand you’re currently leading a hypertension self-management intervention study among Middle Eastern and East African refugees in San Diego. What are the main objectives and expected outcomes of this study?
A: I am one of a handful of researchers who have secured funding from the National Institute of Health to concentrate on refugee health. The focus of my current study, funded by the National Heart, Lung, and Blood Institute, is centered on engaging refugees from the Middle East, North, and East Africa dealing with hypertension in adopting crucial self-management behaviors. The motivation behind this initiative stems from the observed disproportionate burden of uncontrolled hypertension within these communities, resulting in a significantly elevated risk of cardiovascular disease—almost double that of native and other immigrant populations, a fact substantiated by our research. In this study, we are evaluating the feasibility of a pilot intervention designed to promote home blood pressure monitoring and medication adherence. Encouragingly, we are observing preliminary efficacy in the intervention, prompting plans to expand its testing in a larger sample size through a randomized clinical trial design. This progress is particularly promising, given the limited existing literature on interventions targeting blood pressure control among refugee populations.

Could you provide an example of how technology has played a role in promoting health and longevity in your research?
A: I have been conducting trials involving wearables, specifically utilizing connected blood pressure cuffs, to monitor blood pressure among refugees. The goal is to enhance the management of hypertension by empowering patients to take charge of their health while providing healthcare providers with crucial data for making informed decisions regarding medication titration and the most effective strategies for patient care. Additionally, my research has demonstrated the feasibility and acceptability of telehealth interventions, particularly mobile community health worker models, among refugee populations. These interventions have the potential to alleviate various structural barriers faced by refugees when accessing healthcare, including perceived racism, language barriers, and transportation challenges. 

I am currently exploring a behavioral intervention aimed at improving physical activity and reducing the risk of dementia in refugees within international health settings such as refugee camps in Jordan. In these environments, smartphones and internet connectivity are more accessible than traditional healthcare providers. The underlying concept is to leverage technology to deliver knowledge and healthcare to settings and populations that would otherwise lack access. This approach is particularly relevant in addressing health disparities in resource-constrained regions.

You’ve previously mentioned being passionate about mentoring those from underrepresented backgrounds. How do you approach mentorship, and what advice would you give to students and fellows, especially those from marginalized communities?
A: Being a mentor constitutes the most fulfilling and significant aspect of my career, as I firmly believe in the transformative power of individuals. Reflecting on my own journey as a trainee, I encountered challenges in finding mentors who shared my passion for dedicating my research career to refugee health. Unfortunately, many of the mentors I sought lacked expertise or focus in this area, often dismissing my aspirations as "overly ambitious" or merely "passionate." Some mentors exhibited a lack of knowledge about the refugee population and displayed little interest in learning more. Moreover, certain mentors made assumptions about my potential for success in research based on factors such as being a woman, a mother, pregnant, an immigrant, brown, or other characteristics at the time.

These experiences fueled my determination to become a more supportive mentor for individuals who, like me, might be navigating the uncertainty of where to begin. It's essential to recognize that groundbreaking ideas shaping the world often originated from individuals dismissed by those in positions of power and privilege, or even college dropouts. Keeping this in mind, I strive to be mindful of power and privilege dynamics and offer guidance to my mentees.
At present, I am proud to mentor over thirty trainees at the Displacement and Health Research Center, an institution I founded and lead. Our diverse group of trainees includes medical and graduate students, residents, fellows, and postdoctoral fellows, with the majority being from minority backgrounds. Witnessing the growth and potential of this talented workforce in health sciences emerging from our center fills me with immense pride.
To aspiring trainees, my advice is to be tenacious and seek mentors with a proven commitment to areas that align with your interests, emphasizing diversity, equity, inclusion, and accessibility. Consider reaching out to a potential mentor's former mentees to gain insights into their experiences. A transformative mentor or sponsor has the potential to change your life, so invest time in selecting the right ones!

Your involvement in advisory boards of various agencies is extensive. How do you balance your roles as a consultant, key investigator, and advisory board member for organizations like the World Health Organization and the Atlantic Philanthropies?
A: The various roles I undertake as a scientist, advisor, and community member are intricately linked and act as catalysts in numerous ways. My commitment is to produce socially impactful science, intentionally engaging in research projects poised to generate evidence capable of propelling us closer to influencing policies or instigating public health and clinical interventions that address health disparities. In the current era, both within the country and globally, there is a shared awareness of what needs to be done from a moral standpoint to enhance the health of specific populations. However, the challenge lies in the gap between awareness and action. While the complexities behind this phenomenon are manifold, constructive conversations are underway to effect positive change.

Wearing these different hats, it becomes evident to me that a significant root cause often lies in pervasive inequity. This inequity manifests in global economic disparities between and within countries, within healthcare systems, academic institutions, and communities, generating tensions. I firmly believe that science has the potential to alleviate these tensions, as data serves as an impartial reflection. The responsibility lies with us to wield this data purposefully. As scientists, our engagement should extend beyond laboratories, clinics, and classrooms; we should actively partake in conversations everywhere. By influencing minds, offering guidance based on scientific insights, and advocating for the inclusion of marginalized communities, we can recalibrate the equation of inequality. I see this as a crucial step toward ensuring our collective survival depends on fostering inclusivity and addressing inequality at its core.

Looking ahead, what are your future research goals and aspirations? Are there specific areas or populations you are eager to explore in your upcoming work?
A: I'm currently focused on researching the health of immigrants and refugees for the next few years, examining the dynamic interplay of epigenetic, behavioral, and other changes across lifecourses and generations. In our rapidly changing world marked by technology, AI, migration, population growth, climate change, conflict, and inequality, health challenges are emerging at an unprecedented rate. I advocate for a shift from specialized disease-focused approaches, encouraging scientists to adopt broader perspectives for addressing big questions. My current funding supports multi-disciplinary team science projects. The Displacement and Health center, backed by philanthropic organizations, NIH, and the California Department of Public Health, is expanding to study diverse displaced populations, including the unhoused, evicted, and climate refugees.

What would you like the research community to know about you?
A: I consistently remind myself, and anyone reading, that I am merely a drop in the ocean. Lately, my growing fascination with astrophysics and cosmology reinforces the notion that our human lifespan is infinitesimally small compared to the age of the universe. In light of this perspective, I believe in making our brief time on earth meaningful by living a purposeful life. Being a scientist is truly a remarkable opportunity to do so, particularly when we channel the power of science to contribute to saving the planet and humanity!