The 2019 Joseph W. St. Geme, Jr Leadership Award Address: Ubuntu: The Power of Social Connections

In reflecting on what I believe is especially important to a group of academic leaders at a time when the world and medicine seem particularly stressed and distressed, I harkened to an African concept that was explained to me by one of our former residents, Dr Vivian Leuche. She explained the concept of Ubuntu to me in one of our discussions during her pediatric residency.

Ubuntu is a South African philosophy espoused by Nelson Mandela and Bishop Desmond Tutu. There are numerous interpretations of the meaning of Ubuntu and the philosophy perhaps may not translate exactly into English. Ubuntu has special meaning to many Africans.

In general, Ubuntu refers to “shared humanity.” It believes that we are bound together in invisible ways. Nelson Mandela describes what Ubuntu meant to him with the following words:

Ubuntu aligns with an African proverb: “I am because you are. You are because we are.”

It is a term for humanity, a shared humanity: in how we connect to each other, how we grow together, how we accept each other, and how we can lead. Bishop Desmond Tutu described Ubuntu in his statement, “We achieve ourselves in how much we share with others.”² 

Recently, after stepping down as Chair of Pediatrics at the University of Washington and previously serving after a total of 29 years as Chair there and at the State University of Buffalo, I have repeatedly described my experience of being a department chair as a great joy. Joy can be described as an attitude of the heart and spirit. It doesn’t mean the absence of problems, stresses or failures….Believe me, as a chair, each of these happened to me.

In reflection, I have come to realize that my joy from the years as department chair came from my human connections, connections with faculty, residents, students, friends and family. From them, I received the gift of shared humanity espoused in the concept of Ubuntu.

My joy stands in marked contrast to the scourge of “burnout.” But without doubt, excessive stress, mental exhaustion, and depression certainly do exist in our profession as well as in society. A quick search in PubMed in late March found a list of 1480 articles in the medical literature since January 2018 under the search word “burnout.” Sadly, 40% to 50% of physicians express symptoms of burnout in recent surveys.^3–5  Especially discouraging are data that show 40% of physicians also screen positive for depression.³ 

When physicians are queried concerning what is responsible for their unhappiness, often the greatest focus is on system issues such as the electronic health record, the loss of autonomy, requirements for productivity, the lack of time with their patients. The cost of individual burnout or depression or personal pain isn’t trivial. Four hundred physicians in the United States committed suicide last year, more than one a day.⁶ 

We in medicine are not unique. Other careers, while less than physicians, are similarly finding burnout burdensome. Twenty-eight percent of nonphysician professionals with graduate degrees are described as burned out.⁵  In one recent survey of physicians, a control group of diverse working Americans found that 28% of the general public also reported burnout symptoms.⁴ 

Clearly, we live in a stressful world. Perhaps you, like me, even become distressed each morning when we read the newspapers. What we as physicians and academicians do as our life’s work is incredibly demanding. However, if so many others in society are dealing with burnout, something in addition to our repressive regulatory and medical system processes as well as our excessive time demands must be contributing.

What is missing to create so much stress, exhaustion, and depression in our world? I believe that the absence of the values of Ubuntu and the paucity of human interactions may be an important element contributing to “burnout.”

We are called a connected society, but are we? We are a society connected through technology, not through human social connections. We are increasingly connected to technology in a world where time for ourselves and others appears to be shrinking. Work and our devices follow us home and on vacation. In our technology-connected world, many people are lonely. In a recent survey, over 33% of adults say that they are lonely and do not have daily personal interactions.⁷  Worse, 25% say that they have no one with whom to confide when they are in distress. Similarly, half of physicians say that they do not have a trusted advisor.⁴ 

Ironically a recent article reported a study testing a newly developed smartphone mindfulness app to reduce loneliness.⁸  The very tool often accused of replacing social interaction showed that spending 20 minutes a day learning mindfulness improved the number of social interactions over a short period of follow-up. What a contradiction.

A former Howland award winner, Dr Phillip Pizzo, a renowned pediatrician and former Dean of Stanford School of Medicine, describes three ingredients that are essential for joy in life. Purpose, personal health and community or human connections.⁹  Purpose is very important. In studies of physician burnout, the highest odds for burnout were found in those who spent less than 20% of their time in work that they found most meaningful. Meaningful work (which I perceive as a surrogate for purpose) included patient care, teaching, research, and volunteering.¹⁰  Human connections are a powerful component of joy. Connectivity can provide both purpose and better mental and physical health. Lack of social connections has been associated with increased mortality, increased depression, cardiovascular events, and other health problems.¹¹ 

Bishop Tutu says it is impossible to be “human” without interacting with other humans.²  Interacting with other humans gives us purpose, the ability to grow together, to work and accomplish as teams, to provide mentoring and also to have the privilege of receiving mentoring, the opportunity to develop friendships, and ultimately to enjoy healthier lives.

As leaders, we should consider Ubuntu in our leadership philosophy. The values of Ubuntu can be a component of transformational leadership. We all have opportunities for both transactional and transformational leadership. Transactional leadership is often more managerial and asks, “What time and how much?” Physicians often feel pressured by requirements for productivity, lack of scholarly time, requirements for grant funding, and multiple directives sent by e-mails without an opportunity to discuss or understand the genesis of policy decisions.

Transformational leadership creates a vision and inspires. Transformational leadership offers an opportunity to share the spirit of Ubuntu. It encourages pursuing a common mission, it listens and respects the team, the leader demonstrates humility, she shows compassion, he treats colleagues as if they were family, they coach and support others, they articulate the culture of Ubuntu or shared humanity.

Transactional leadership and transformational leadership can and should coexist. I would like to offer an example of a leader in Seattle who articulates the spirit of Ubuntu and also is a highly transactional and goals-oriented leader, Satya Nadella, CEO of Microsoft. In his book Hit Refresh,¹²  Mr Nadella describes his efforts to transform the “soul” of Microsoft and to position Microsoft for leadership in the future world. In his book, he states in various excerpts, “Culture is everything.” “We will grow a company if everyone, individually, grows in their roles and in their lives.” “We are a family of individuals united by a single, shared mission.” “It is our ability to work together that makes our dreams believable and ultimately achievable.”

And transform Microsoft, he has.

Another perspective on personal leadership based on human connectivity is offered in the well-known leadership book by Kouzes and Posner¹³  from the distinguished General John Stanford, who was a Seattle resident prior to his death. To quote General Stanford, “The best-kept secret of successful leaders is love: staying in love with leading, with the people with whom you work, with what their organizations produce, and by honoring those who honor the organization by using its work.” I think that this view is very applicable to academic leadership. He finishes the thought by saying, “Leadership is not an affair of the head. Leadership is an affair of the heart.”

In receiving this award, I owe much to colleagues who have demonstrated the values of Ubuntu and shared their passions with me. One of the first faculty colleagues to greatly influence me in my career was Dr Fred Rivara when we were both assistant professors at the University of Tennessee in Memphis. Fred, who is Vice Chair of Pediatrics at the University of Washington, among other national leadership posts, has been one of my closest friends, advisors, and a role model for integrity, excellence, and advocacy. He is one of the most accomplished researchers and advocates for safety and accident prevention in the world today.

Dr Doug Jones, former Chair of the Department of Pediatrics at the University of Colorado and former St. Geme Awardee, asked me to join him in the late 1990s when we were on the American Board of Pediatrics to colead a reexamination of fellowship requirements. That effort led to the current expectations for a robust curriculum and academic oversight of fellowship programs.

During the effort to reexamine fellowship training, Dr Ted Sectish, then president of the Association of Pediatric Program Directors (APPD) and I, president of the Association of Medical School Pediatric Department Chairs (AMSPDC), realized that there was no mechanism at that time to bring all pediatric subspecialists together to discuss and advocate for pediatric subspecialties and especially to address fellowship programs. Later, we were joined by Dr William Schnaper and Dr Richard Behrman. Together we were able to create the organization the Council for Pediatric Subspecialties (COPS), which continues to be an important voice for pediatric specialists.¹⁴  Work by COPS ultimately has led to the current postgraduate level 3 universal fellowship match, which we championed back in 2006 as one of the reasons to create COPS.¹⁵ 

When I had the privilege of being president of the American Pediatric Society (APS), I realized the absence of a focus on diversity and inclusion in our strategic plan. In consideration of how the APS might address diversity and inclusion in academic pediatrics, Dr Elena Fuentes-Afflick joined me and chaired a task force and later a standing committee on diversity and inclusion that has led to a significant and, I believe, a wonderful evolution of this meeting and the APS and all our societies.¹⁶  Dr Fuentes-Afflick is past-president of the APS.

Mentorship is a value of Ubuntu. Several wonderful role models for mentorship have enriched my career. Dr Susan Marshall, Professor of Pediatrics and Vice Chair of Medical Education in Seattle, is a leader in student education. She is a tireless advocate for education and well-being of medical students at the University of Washington and in the Council on Medical Student Education in Pediatrics (COMSEP). Another leader in career development is Dr Nancy Spector, Professor of Pediatrics at Drexel University and head of Executive Leadership in Academic Medicine (ELAM). Dr Spector is a leader in faculty and leadership development, particularly promoting opportunities for women faculty. Dr Richard Shugerman, Professor of Pediatrics and Vice Chair of Faculty Development in the Department of Pediatrics in Seattle, is a national leader in resident well-being and has supported countless residents as they transitioned into pediatricians. These three individuals have an abundance of the Ubuntu qualities of compassion and empathy. They each expanded my vision of how important it is to support the careers of others.

Ubuntu also allows for personal growth as a result of others sharing their innovative passions. Individuals who have shared their remarkable passion for innovation with me include Dr Bonnie Ramsey, Professor of Pediatrics and Vice Chair for Research in Seattle, who has changed the world for children with cystic fibrosis with her development of inhaled tobramycin (Tobi) and her leadership in the development of each of the current and emerging CFTR (Cystic Fibrosis Transmembrane Conductance Regulator gene) modulators. Another great mentor was the late Dr Russell Chesney, who also received the St. Geme Award. Russell always asked the most insightful questions and was so kind to younger academic faculty and to me. Another unique and outstanding mentor was the late Dr Richard Sarkin who taught me about the skills of teaching, as well as the need for reward systems for faculty teaching. Rich and I scheduled a dinner together at each PAS [Pediatric Academic Societies] meeting until his untimely death. How lucky I have been to have received their gifts of inspiration.

I have always enjoyed a quotation which has been so relevant for me from my human connections. “Count your age by friends, not years and your life by smiles, not tears.”¹⁷ 

Expanding our human relationships and caring for each other will not solve all the stresses and causes of burnout. Yet in a world that is so fractured by nationalism, racism, intolerance, partisanship, economic disparities, gender and religious disagreements, and other conflicts, this is an especially fitting time to embrace the values of Ubuntu and expand our human interactions.

In the epilogue of the 1993 Interim Constitution of South Africa, it is stated, “There is a need for understanding but not for vengeance, a need for reparation but not retaliation, a need for ubuntu but not for victimization.”¹⁸  Could there be a better message for us today?

I hope that we academic and clinical pediatricians might consider bringing Nelson Mandela’s Ubuntu values into our daily lives. I offer the following suggestions:

• As individuals and leaders, we can model humility, kindness, compassion, generosity, and forgiveness.

• We can expand our repertoire of social connections. Introduce yourself to fellow academic pediatricians. We are all members of the same pediatric academic family. You might discover new colleagues, mentors, or mentees. She or he might be a catalyst for your career or you for theirs.

• When you recognize friends or colleagues in distress, it is especially important to reach out to them and to offer or find help.

• In our organizational leadership roles, we should align transactional decisions with the humanity of Ubuntu. Take time for developing trusting relationships.

• We should support, recognize, and celebrate our colleagues when we see them commit acts of service, kindness, and compassion. How often do we say “thank you?”

• We should take care of ourselves, mentally and physically. I have frequently said to our residents that a physician needs to be physically and mentally strong so that your patients and loved ones can lean on your shoulder. Self-care is a form of compassion.

• We all feel overwhelmed at times. Reach out to others for support when you need it. Or perhaps in the future, we will look for that app for loneliness.

In receiving this award, I reflect on Ubuntu and its potential for making our lives, workplaces, and communities more rewarding and joyful. “I am because we are.” My accomplishments have been gifts shared with me by many others. As I receive the honor of receiving the Joseph W. St. Geme Jr Award, I thank them.

APS

American Pediatric Society

COPS

Council for Pediatric Subspecialties