Trusting your instincts for maximum impact with Dr. Christina Cruz

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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

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to build their own research program, whether or not they have a mentor.

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As clinicians, we spend a decade or more as trainees learning to take care of patients.

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When we finally start our careers, we want to build research programs, but then we find

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that our years of clinical training did not adequately prepare us to lead our research

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program.

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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

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However, clinicians hold the keys to the greatest research breakthroughs.

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For this reason, the Clinician Researcher podcast exists to give academic clinicians

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the tools to build their own research program, whether or not they have a mentor.

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Now introducing your host, Toyosi Onwemene.

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Hello everyone.

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Welcome to the Clinician Researcher podcast.

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I'm your host Toyosi Onwuemene, and I'm delighted to be here today because I have a very special

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guest, Christina Cruz.

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Dr. Christina Cruz, welcome to the show.

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Thank you so much for having me.

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Well, Christina, you are an amazing, phenomenal physician scientist, and I'm so excited to

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have you on the show.

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And I just want you to just introduce yourself to the audience, especially kind of give us

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the story.

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How'd you get here?

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How do you get to do this thing called being a physician scientist?

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Well, again, thank you for having me.

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So I am a child psychiatrist at UNC Chapel Hill and a global mental health researcher.

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And a lot of my work centers on a therapy I invented that teachers can deliver in the

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classroom while they're teaching students to try to increase access to care in places

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in the world without mental health professionals.

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How I got here is a longer story.

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I actually, once upon a time, was actually in business and a management consultant and

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had an aha moment when I was with my firm in a hospital where I had wanted to actually

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be on the other side of the interaction where the healthcare was happening and not consulting.

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So I quit my job, went back to school to go into medicine, was fortunate to get into med

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school and then promptly realized that medicine was imperfect and that I needed to work towards

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the health of others outside of medicine.

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And so I took a year off to get a master in education.

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And at that time, a friend had approached me about potentially doing school mental health

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in Darjeeling and I was already interested in psychiatry and school mental health with

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a master in education, thinking about how schools could be a platform for mental health.

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So as a med student, you don't often get to do cool things.

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And so I immediately said yes.

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And that was the birth of Tealeaf, the therapy that I created.

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And so now we're 12 years out and Tealeaf is across 40 schools in Darjeeling, India,

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where it was born and raised, I like to say.

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And we're newly expanding now to Manila and the Philippines, which is a country that holds

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important my family.

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And so I'm excited to talk to you about the journey and what it's been like, because it's

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been, I'll confess, a bit roundabout.

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And to be honest, research was actually never on the mind until it was clear that it was

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the way to go.

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Okay, you said a lot, Christina.

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And the thing that I just want to pause and double down on is Tealeaf.

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Oh, tell me about that.

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Yeah.

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So Tealeaf stands for teachers leading the front lines, mental health.

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It is a nod to Darjeeling, India, where it was born and raised, like I said, and that

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that's the local industry.

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And so we wanted to ensure that anything we created was very clear that it is a Darjeeling

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product, given that the communities who wanted this.

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And so my med school classmate at the time is now also a physician, and approached me

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about going to Darjeeling to think about school health, school mental health, rather.

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He and his wife were teachers in Darjeeling for a couple of years, and they were going

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back to start a nonprofit around school health.

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Kids were dying of diarrhea at higher rates than the world was.

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And so they really wanted to tackle that issue.

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But as teachers, they also very much knew that mental health was in the classroom.

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The prevalence is about one in five kids after COVID.

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Now it's closer to two in five kids with mental health concerns.

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But there are no resources really locally in Darjeeling to address it.

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And so I was really convinced with my friend's name is Mike Maturja and Dana, his wife, that

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teachers would be a way to kind of get in there to provide care.

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But it had to be done in a way that could be sustainable, because there are obviously

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teachers who are there to teach, not to be mental health clinicians.

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So I approached my master's in education with this idea in mind and started to craft it

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over a couple of years until it got to the point where we made therapy interventions

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that could be done in 30 to 120 seconds.

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When teachers are already supporting their students with mental health concerns, what

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they're doing right now is providing informal support.

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And what we've done is craft cognitive behavior therapy and dialectical behavior therapy,

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CBT, DBT techniques to be used in those moments.

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So informal moments of support become doses of formal care.

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So that's Tealy.

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I love it.

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I love it.

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Okay.

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So even going backwards, businesswoman turned clinician and evolved into a researcher.

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What an amazing story.

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So you are creating, you're crafting, you're building, you're molding.

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Who's been guiding you along this process?

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How is this all?

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Where did you find the mentoring to do all of this?

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Well, it started in part in medical school.

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I had the really good fortune to have role models who were very busy, but started me

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on this path of thinking about global health, global reach, and how does one do something

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big?

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And I'll credit actually the individuals, they're famous.

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One is deceased, one is Jim Kim, and one is Paul Farmer.

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They were professors of mine in medical school.

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And I got to know Paul Farmer, not well, but just enough where he became somewhat of a

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mentor.

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And he obviously, I don't know how much folks on the podcast know, it's just a huge presence

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in global health.

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Unfortunately passed away last year, but really, I think changed the face of how you can think

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about your impact as a clinician through both research and programming that can become global.

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So it started there.

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And then I've had different mentors along the way who have helped me to flush out ideas,

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such as in the education school, thinking about a pediatrician who is there who thought

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about school health, or now at UNC where I'm still early career faculty thinking about

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my mentor here who helps me think about task shifting, which is what Tealife is, is having

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community members deliver professional care on some level.

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But it's not been one person, I would say, who's really directed everything.

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It's been my ability, thankfully, to know when I don't know what's happening and having

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to turn to someone, find someone who can help guide me through those moments or those problems.

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I love it.

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I highlight many things that I find valuable and I highlight on this podcast, which is

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number one, you were talking about mentoring networks, there was not the one person that

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you could point to, even though you had Paul Farmer as a mentor, you didn't have one person

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that you could point to and say, this is the person who led me all the way through.

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And that it kind of shows up in your career because you've built something that's unique

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that I think draws from all of these strengths to make something pretty amazing.

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And so there's the concept you draw on about of mentoring networks.

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And then the other piece is self-direction.

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So you are actually leading your career.

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So where do you get the, I think maybe the word is hudspah to do that.

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Like, where does that come from and how dare you?

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You got right to my heart.

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So I'm a New Yorker actually and a New Yorker in North Carolina and I use hudspah about

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once a week as a word.

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So yes, how dare I?

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Well, I will just say that I think it comes from a deep belief that may or may not be

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naive that I can do something useful.

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And it's not that I don't respect the systems that are out there, however imperfect.

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In fact, I've come around to really respecting them in that it's years, sometimes like hundreds

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of collective years of people's knowledge and wisdom, putting something together the

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best they can.

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And so I see those as really important in terms of working within, but also learning

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from.

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But knowing that they're imperfect and that in my heart of hearts, having expertise kind

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of across three different, very different fields, business, medicine, and education,

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that there are ways to put them together that might create something new that others may

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not see simply because they don't have the background to see it.

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And so that's where the hudspah comes from.

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It's just kind of enough confidence in myself, though let's be clear, lots of imposter syndrome

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happens to be able to bring something into the world that I'm pretty sure others haven't

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done because no one's put the three together.

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It's an experiment.

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Yes.

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Is it working?

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I think so.

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That's what the evidence is showing as I've learned how to be a researcher to show that

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in fact works.

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I love it.

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I love it.

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You are owning your own strengths and the spaces in which you shine as the expert.

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And what you've done is instead of saying, well, this is what's popular.

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I'm not the expert in that.

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Let me keep trying to make this work.

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You said, no, where do I have expertise and how do I create something that I understand

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and can move forward?

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That's pretty impressive.

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You are very kind.

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Thank you.

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I will confess, all started in medical school when I was having finished third year, which

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we all know is our hardest year as a med student and just looking for something else.

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I had finished surgery.

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I'm a psychiatrist.

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Again, surgery is very far from my daily life right now.

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And I needed honestly a pick me up and having had a consultant kind of brain, this was a

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great way to put everything together to think about how systems come together in a way that

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I knew hadn't really existed.

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Though of course, tenants did exist such as exceptional children's or special education.

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Some of it's based in that.

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Some of it's based in CBT and DBT.

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These are all in existence, but it was rejuvenating and grounding to be able to come to a project

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like this after having gone through what I call the slog of third year.

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Yeah, it definitely is a flag.

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And what I hear you saying is that you were searching for the meaning in all of your experience

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and where you didn't necessarily find it in the way you wanted, you created it.

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You created meaning out of your experience and looking to really make an impact.

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And I think that's why many of us come to medicine.

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I mean, we're clinicians first because we really want to make a change in the lives

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of our patients.

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And so you saw opportunity and you're making change happen, which is amazing.

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Now you make it sound easy.

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You're like, I did this and then I went across the world and I started this thing that's

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now in 40 schools.

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So what have been some of the challenges along the way?

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There have been many.

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I think to get into the weeds, there are always logistical challenges, working internationally,

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understanding different laws, cultures.

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I'm sure everyone's experienced it on some level as you even just managed both being

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a clinician and a researcher.

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I think the biggest challenge though to step back that that kind of forms the foundation

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of is by creating something essentially no one has done this before.

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And it is both thrilling and terrifying to think about what my next step might be.

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Every day I wake up and I have to make my own list of what I'm supposed to do and think

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through is this important?

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Is this not?

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Is this going to further tea leaf?

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Is it not?

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Am I wasting my time or does someone need to do this?

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So there are all these, I think it's the decision making that really has been the most challenging

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because it feels as if not but there haven't been innovators before, of course, but no

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one's done exactly this.

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And so what do I do day to day?

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What is the long-term vision?

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It all kind of rests on me and my team.

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I do of course have a team, but together that's it.

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There are no checks.

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And on some level, like I said, it's terrifying in that at the end of the day, I feel like

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we're taking children's wellbeing into our hands, but happily we've shown enough that

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children do in fact improve that I can sleep at night trying to chart a new path because

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ultimately my goal is of course to get care where I can when I can.

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Sure.

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So the obstacles I'm hearing are the real challenges of doing research across country

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lines.

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I mean, we struggled to do research with our colleagues in the same division.

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You've managed to do it across country lines.

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And then also just thinking about the fact that this is brand new.

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And so in a way you're making it up as you go along and it's like, are we doing the right

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thing?

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Are we doing the right thing by our patients?

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And that challenge of making sure that you are honoring the rights and respecting your

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patients as well.

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I like that.

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Absolutely.

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So tell me about what, for someone who wants to do work in, I mean, this is global health,

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global research, right?

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People want to do this.

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If you could kind of create a new playbook for someone who's just starting, what would

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you recommend now that you've kind of done it and made the mistakes?

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How would you do it over again?

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That is a really, I think, interesting and difficult question in that I consider my path

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fairly atypical, particularly having come to research as almost a fourth career.

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So what I will say though, with regards to global health is I do think it's important

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to find, I'm going to call them an advocate rather than a mentor in that you've discussed

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how I've had more of a network of mentors rather than a mentor.

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And so I would start with finding someone who you can just bounce ideas off of, or who

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can help you with thinking about projects or sites because the world is really large

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and it can be overwhelming to think about what you might do.

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And you might not quite know what is needed somewhere else, or even if it's say like the

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next town in the United States, right?

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So I think that having some guide, some advocate is helpful.

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I also think that I would suggest folks think through what is their goal?

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What does the community need?

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And then how does it come together?

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Because I think what I've learned from Tealeaf is that it took a few years for it to really

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become honed in on this 30 to 120 second interaction with teachers.

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I despite being a consultant, my strongest training at the time and still is, is now

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medicine and psychiatry.

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And so I came at it from a diagnostic angle of teaching teachers how to think about diagnoses,

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but actually it turned out not that they don't care, but they don't need to know that.

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They need to know what to do in those moments when the mental health symptoms are escalating.

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And so it really took thinking about what was my goal?

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What did the community need?

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And then coming together.

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And I still think it would have taken a long time to get to Tealeaf, for example, but maybe

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it would have been faster had I been much clearer on exploring with the community exactly

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what they were looking for and then helping them through, because they probably also don't

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exactly know either.

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So I would say to summarize an advocate, as well as really exploring on the big meta level,

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what do you want to do?

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What does the community want to do and how do you come together?

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I love it.

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Now tell me about partnerships.

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So I mean, one of the things that's important, and I think you mentioned is just the importance

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of collaborators in this process.

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So how do you go about finding collaborators?

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Is it all serendipity?

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Yes and no, it's serendipity in that I think, excuse me, one second.

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It's all serendipity in that you may not know when that opportunity is going to come.

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And so at some point it will feel like, gosh, wasn't I really lucky to come across this?

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But I think the reality is that you make it happen.

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You set up the environment, you set up what you're looking for to reflect or to try to

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bring that opportunity up.

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And so for example, with my experience, Mike and I had been friends throughout med school.

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There was no business transaction to be had or NGO to be started.

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It was simply, we both had similar interests.

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We had a group of friends with similar interests and we would just talk.

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And then we would talk a lot throughout third year with not knowing what the future held,

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except that I needed to get up by five in the morning the next morning to ensure I could

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retract skin for the surgeon.

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And that's really all I knew.

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But we would have these shared experiences where then when we both came to what we next

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wanted to do, which was me thinking about school mental health and him going to Darjeeling

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to start school health, then he knew exactly who to turn to.

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His friend who had shared experiences with shared philosophy and was going to do the

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other thing that he was interested in.

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And it was easy for me to say, I knew him and I knew that he was a good person doing

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good work.

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And it was an opportunity for me that I had been looking for.

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So it felt it feels like on some level, it's still lucky.

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I don't doubt that, but I sure did.

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And so did Mike and a lot of people create the environment and stay on the lookout for

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these opportunities so that when they do happen to come, you know, that's it and you go for

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it.

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I love the way you put that.

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It's the people who are prepared in a way have set a trap for opportunity.

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Essentially, that when it comes along, they're more likely to catch it.

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That's right.

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I love it.

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So it is it is preparedness because you know, the if you weren't if you weren't thinking

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actively about how to make use of it, it might have passed you by and you would have missed

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the opportunity as well.

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Yeah, yeah.

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And to look for and to recognize it because I could have also said, you know, I'm going

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to get my masters this year.

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Thank you for this wonderful chance, but I'm going to focus on this thing.

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But and it was overwhelming to all confess because I was pregnant with my first child

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and about to deliver.

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So there are a lot of things happening, which is a theme in my life, a lot of things happening.

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But it was one of those moments where I sat down and thought, no, this this is a good

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one.

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Like I need to try.

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I might fail a lot.

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I might take a long time to get there because it's everything happening.

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But I think I have to try and I just will put out there to my potential.

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You know, now, Koki, I this is what's going on in my life.

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But I really think this is important.

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Can we work together based on these constraints?

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And it so far has worked out.

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All right.

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So I'm hearing something that I just want to double down on.

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So you were busy, overwhelmed.

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There was a lot going on in your life.

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But still, when this opportunity came, you had the mental space to sit and consider that

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it was a unique opportunity that made sense to take advantage of.

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And so it sounds like you probably have to move some things out of the way to make room

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for this, but you really had the mental clarity to recognize it for the opportunity that it

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was where in the in the place that you were, you could have easily said, I'm too busy.

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There's no time for this.

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It's not the highest priority, but you recognize the uniqueness of the opportunity.

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So tell me about what what what created those that space for you that you were able to do

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that well.

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Well, I think a couple of things like very concretely, my husband's always been a very

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supportive person and has always encouraged me to reach farther than I think I could reach.

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And so it's it's just kind of part of how we operate together.

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So I think that's the basis in which I am fortunate to have that so that I can pursue

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things despite everything happening in my life.

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The other piece that I think is really important is that I knew in my heart of hearts that

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I wanted to have a global impact.

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I wanted to have the chance to do something that would affect the U.S. and beyond if only

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I could find it.

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But I had known this coming into medical school, which I alluded to in that I turned to medicine

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already as a second career, and part of my reflection was that as a management consultant,

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the impact I was having, which is, of course, improving a business, just wasn't the impact

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I was looking for.

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And so when I did my own thinking through what am I going to do now with my career,

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it was clear to me that a global impact through health was what I was searching for.

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And so I knew that from the beginning.

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And so even though there was a lot going on, there was some part of me in the back of my

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mind that knew to look out for this.

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And so when it finally came, it was clear to me that I was going to do something that

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was important to me, and I knew that I was going to do something that was important to

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me.

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And so when it finally came, it was clear to me that I was going to do something that

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was important to me.

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And so even though there was a lot going on, there was some part of me in the back of my

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mind that knew to look out for this.

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And so when it finally came, I did need to take a moment because my first reaction was,

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Mike, are you kidding me right now?

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I had no choice, I don't know that you had any other friends doing this kind of thing

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or would do it for free.

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So.

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Sure.

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No, no, no, that's really, that's amazing.

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That's amazing.

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It's that you had a very clear internal compass on what you had imagined for your future.

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And so when this opportunity came along, it aligned with that.

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And that's why you had the opportunity to really give it some consideration.

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That's beautiful.

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That's beautiful.

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All right.

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So we're almost out on the end of our session and I want to give you the opportunity to

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say something that we've left on set.

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Someone's looking at you and they're like, wow, Christina's career is so amazing.

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What insight do you want to share with them about how they can think about their own journeys?

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I would say the biggest one is to go with your gut.

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I will say I have followed my gut almost the whole time and it has mostly not led me wrong.

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You do have to check it a little bit because it is your gut and there are real constraints

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in the world or things that might be fantastical, but aren't necessarily possible.

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But I think to listen to what you think is right and then trying to figure out a way

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to do it is really the way forward, at least for me.

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And I think that's why my route was so circuitous yet landed on something so meaningful.

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So I would say go with your gut, work with it.

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As I mentioned when I was talking about the tea leaf offer from like sleep on it a few

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days, that helps.

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But generally speaking, by going with your gut, which I think is a reflection, it sounds

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cheesy of being true to yourself.

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That's how you can move forward because you will have to be internally motivated to be

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a clinician researcher.

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Tony Ose talks about this on all the different podcasts on the website about how it can be

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really hard and sometimes a lonely journey.

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And so I think to have yourself to motivate yourself every day is most important.

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And that happens when you're true to yourself and listen to your gut.

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I love it.

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So beautifully said, there's just nothing more to add to that.

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You're so kind.

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Oh my goodness.

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Christina, it has been a pleasure, a pleasure to be on the show.

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Thank you for being here.

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Thank you for having me again.

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Well everyone, you've heard Christina, you've got to trust your instincts.

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If you know it just feels right, you got to explore it.

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At the very least, explore it, investigate it and see how can you make it possible.

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Someone's got to hear this episode.

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And so I want to ask you to just find one person, just one person who's even thinking

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about global health research and share this episode with them.

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And definitely, I think more clinicians just need to be moving forward, moving forward

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the research ideas that they have, whether or not they're supported, but finding the

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areas of support where they can find them.

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All right.

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It's been a pleasure talking with you today.

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We look forward to the next episode.

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Thanks for listening to this episode of the Clinician Researcher Podcast, where academic

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clinicians learn the skills to build their own research program, whether or not they

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have a mentor.

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If you found the information in this episode to be helpful, don't keep it all to yourself.

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Someone else needs to hear it.

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So take a minute right now and share it.

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As you share this episode, you become part of our mission to help launch a new generation

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of clinician researchers who make transformative discoveries that change the way we do health

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care.