As some of you may know, I am doing an Executive MBA in Healthcare Leadership at the Yale School of Management in my “spare” time. I love the program and am learning a ton. There was something a professor said the other day—no, not a novel way to think about linear programming, problem framing, or process efficiency, but a remark he made in passing that stayed with me. He said that there’s a Chinese saying about the determinants of success. The first determinant is your parents (it’s hard to increase wealth significantly over one’s parents in one generation, but easy to enjoy great wealth if you have the right lineage—think Rockefellers, Kennedys, etc.). The second is luck, the third is who you know, the fourth is accumulated karma, and if you have none of those, you’d better work hard.
That concept resonated tremendously with me. My parents are middle-everything: middle class, middle income—they are not doctors or lawyers, nor high-powered bankers or politicians. My brother and I (both surgeons interested in oncology) did not get to where we are based on parental stature or wealth. Neither of us could have checked the box that says “Child of Yale Alum” on a Yale School of Medicine application. We were lucky for sure—we were blessed to have outstanding teachers and mentors, and got to know a myriad of people who opened doors for us. Our parents always taught us the importance of doing good deeds—a sense of social responsibility that no doubt added to our accumulated karma. And then, of course, we were taught to work hard—really hard
. My parents were immigrants who had to pull themselves up by their bootstraps, and we had to do the same. When tough times came (as they always do), the answer was always work harder
. While other kids’ parents paid for their college tuition, my brother and I put ourselves through school on scholarships. It was simply what we needed to do, and we never thought for a moment about asking our parents for support.
I thought about this further this past week, when Dr. Mercy Isichei, a surgeon from Nigeria, visited Yale as part of an ASCO International Development and Education Award (IDEA)
. She told me about life expectancy in Nigeria being 45, and the diseases that were rampant in her country, the fact that breast cancer there presents late, treatment is limited, and prognoses poor...I thought about the inequities of life—it’s simply not fair. We don’t get to choose who our parents are, nor where we are born. If you happen to be born into poverty, your lot in life will be very different from those who are lucky enough to be born into wealth. Often, you are limited in who you know based solely on social circumstance—which is why programs like the IDEA and other international initiatives that link people together hold so much promise.
But no matter how much good karma you’ve accumulated and how hard you work, life will always be harder in low- to middle-income countries than it will be in wealthier parts of the world. But, as I talked to Mercy and another surgeon from Nigeria I met at the Breast Cancer Symposium, I was struck by their sense of optimism. No matter how bleak, things can always get better—and they will—but the question remains: how do we address global inequities in cancer care? I would love your thoughts and feedback!