As chief medical officer and VP of clinical innovation at OSF HealthCare, Dr. Sarah de Ramirez is an integral member of the OSF Innovation Team, which seeks pioneering solutions to healthcare’s biggest problems. At the University of Illinois College of Medicine Peoria, she serves as associate professor of emergency medicine and director of the Innovation in Rural Global Medicine program. Having done HIV work in Africa; studied at Harvard Medical School and the London School of Economics; and worked with the Bill & Melinda Gates Foundation, the United Nations and other international organizations, she brings a broad-based, global perspective to this critical work in Peoria.
Tell us about your family and childhood. Who or what were early influences on you?
I grew up in Germantown Hills when it was still a smaller town amongst cornfields. I had all the things a kid would be lucky to have: a great neighborhood with friends always ready to build leaf forts in the fall, play hide-and-seek and catch lightning bugs in the summer, and build snow igloos in the winter. Most of all, we were lucky to have awesome parents who lived lives of service. My mom was a special education teacher, then a school principal, and eventually a vice president at Illinois Central College; my dad was president of the bank that is now PNC. They instilled in me the importance of service and how each of us has a responsibility to contribute to the lives of others.
My parents grew up in small farm towns themselves, and while they always wanted us to remember where our values came from, they didn’t have any traditional small way of thinking. They viewed their role as to help us grow, question social norms, and not see barriers where others might. They supported every effort of mine to break through them: to play on the boys soccer team (since there wasn’t yet a girls team), to take honors math when I was told “algebra would be fine,” and to go to Haiti when most people thought I was talking about Tahiti.
My parents’ church had a big influence on me as well. By bringing in missionaries from around the world, their work showed me the diversity of global life experiences and planted the seed of authentic engagement around issues of equity. I was always saving money for something… building wells for clean water in India, supporting school fees for kids in Ghana. It seems small, but I think those early experiences forced me to realize how “normal” things like water and school were “givens” for me, but that someone, somewhere, was depending on me to help them have that same privilege.
My dad actually recognized my passion and helped facilitate my first global medical work in Haiti when I was in my teens. I remember flying there—how our first stop was Miami, with all its glitz, while 90 miles away was some of the greatest human suffering I had ever witnessed. I saw how medicine could serve people and how strategically placed resources could make a huge difference in people’s lives.
How did you decide to get into healthcare? What were some formative experiences along the way?
I was interested in sociology and anthropology in high school. Understanding how other sciences and cultures understood the world always fascinated me, and I suppose ultimately led me to the interdisciplinary field of innovation. But as I continued to work globally, I also realized the shortfalls of medicine.
I remember one of the kids we helped get from Haiti to the U.S. for a life-saving heart procedure. On a subsequent trip, we went back to his village and found him emaciated—the result of living in poverty. That’s when I realized equal access to healthcare is definitely a basic human right, but that I’d always come up short if that was my only focus in approaching health equity. It seems simple, but systems all over the world make the same mistake every day: thinking that we fix health inequities with healthcare access alone. That awakening made me realize that I wanted to approach medicine through the lens of public health and economic development.
During college, I continued to work in Haiti while also becoming interested in scientific research. I started to read a lot of medical anthropology work from Paul Farmer, who was trying to discover new methods to deliver healthcare and HIV/TB therapy in some of the world’s poorest countries by telling the stories of the patients he cared for. He really is a visionary. I always thought if I could do work like Paul, I would feel like I did something useful with my life. He was unapologetically honest about how every choice we make as clinicians, institutions or governments can give or take life from people.
I decided to apply to Harvard, where Paul taught, and somehow I got in. I remember thinking on the first day of med school that they were going to send me away, saying there was an admission error. But before I ended up matriculating to Harvard, I received a U.S. Fulbright award to work on HIV in Namibia. I knew I wanted to work on issues related to public health and HIV before I went to medical school; it was one of the largest pandemics of our time, and access to care was so limited despite the large number of individuals infected in poorer countries. So I worked with the Namibian government, USAID and UNAIDS, helping to develop the first HIV education curriculum for the newly independent country.
After that work, I received a Marshall Scholarship to study at the London School of Economics and the London School of Hygiene & Tropical Medicine. I was fortunate to receive a master’s degree in public health and another in economic development. It was really impactful to learn this science outside of the U.S., where systems of public health are quite different, and with truly global classmates. Understanding there are many ways to put the principles of public health, medicine and social care into practice is something I still carry with me today. My thesis was based on my work in Lima, Peru, working with Paul Farmer and helping women who had drug-resistant tuberculosis. We partnered with the government and a nonprofit organization to overcome social and structural barriers so women could receive daily treatments and eventually be cured. I learned how the health systems and communities which take ownership of solving the root causes of poor health and illness ultimately benefit economically as well.
Can you tell us more about your work with the Gates Foundation and other international organizations?
After a year at Harvard Medical School, I was nominated for the inaugural Bill and Melinda Gates Global Health Fellowship. Although it meant leaving medical school for a year (when I had just arrived), the Gates Foundation was becoming such a change agent for global health that I ultimately decided to apply and was later chosen.
At the Foundation, I saw how resources change strategy—how money creates the roadmap to medical discovery. Bill Gates always spoke about the need to create “leap over” technologies. In other words, we need to be investing money where the science needs to be to help populations leap over stages of economic development. He believed part of the role was to incentivize the pharmaceutical industry to innovate around solutions for health equity. For instance, they could work with large companies to put scientists on vaccine development for diseases they otherwise would not have been dedicated to because there was “no paying market for the product.” My worlds of technical research, health equity and innovation truly collided there, and the patchwork of all my experiences started to gel.
As faculty at Johns Hopkins, I helped lead Johns Hopkins Global Emergency Services, examining efficiencies and equities throughout emergency departments in the Middle East and Latin America. We formed a global research and innovation network, and I got to work with teams of Hopkins engineers to create solutions to challenges in health outcomes. It was so fun to work with different disciplines, create new tools, and trial them in emergency departments around the world with different cultures and processes. That was when I really started to see the impact multidisciplinary innovation could have on the lives of people if we put their needs at the center of our design process.
Describe your current work at OSF HealthCare. What projects are you most proud of? What are you working on currently, and what lies ahead?
At OSF HealthCare, I took the first position in my career that wasn’t globally focused. This opportunity went back to my interest in the roots of health disparities; the recognition that vulnerable populations exist everywhere, including our own backyard; and the belief that challenges in rural areas were similar across the globe. I saw an unprecedented opportunity to fuse my work in population health, social determinants of health, medicine and health system innovation to create new tools and technologies.
At the Jump Trading Simulation and Education Center, I’ve been lucky to be part of a very talented team that dreams big about how to change healthcare to meet the needs of all patients. I’m most proud of the work we have done innovating ways for our clinicians to elicit the social needs of patients alongside their medical needs. We created tools to screen all patients for social determinants and get them the help they need; now we can move on to predictive modeling and natural language processing so we can offer interventions even before patients come to us. We’ve also used this process as we digitally enable community health workers to reach outside the walls of the hospitals and serve the community. The Pandemic Health Worker program was a great example of that work, and it’s been awesome to see how we could care for patients across the state using new digital technology. It really shows you the possibility for global reach of these new models of care.
What about your role at the University of Illinois College of Medicine Peoria?
I’ve really had a great time there as well. I was able to create a four-year course called “Innovation in Rural-Global Medicine (IRGMed),” which teaches the principles of innovation, rural medical care, and how to identify opportunities for innovation that help achieve health equity in a population. The faculty and students are awesome, and we recently inaugurated our global partner site at Mbarara University in Uganda, working together to innovate new solutions to common problems in the rural U.S. and rural Uganda. It has been really incredible to see the students grow in their understanding of health equity and innovation, as well as clinical knowledge.
What is your secret to maintaining a balance between your community work and personal life?
Ha! I don’t think I’ve achieved any balance. Balance implies that you are trying to do one thing or another, weighing them against each other. It may just be my crazy life, but I feel like it’s all just kind of integrated around my passion and purpose, fulfilling me in different ways. Like anyone, I set priorities for what I think are must-have experiences with my kids, that I’m going to show up for every time. And sometimes I guess wrong. Or I show up late. Or I bring Oreos instead of home-baked cookies. But I think when you engage your kids in your passions, they get it. My parents showed me that you can be there for your children and also impact your community. I believe it’s a good lesson for children to learn—that being dedicated to what matters does involve some sacrifice. Living life with intention is a decision you make. If all things are important, you get burned out and forget the purpose that brought you there.
What advice would you give to a young, up-and-coming female professional?
Embrace new experiences, even when you don’t understand exactly how they relate to your path. Every opportunity is a chance to grow and learn how someone else approaches a problem. Be open to learning from other teachings, cultures and communities—because the experiences you accumulate in life influence your knowledge and ultimately frame how you lead.
Broader perspectives form broader solutions and help more people. Being humble enough to understand there may be people somewhere else in the world with fewer resources than you who have already figured out the solution is also important. That’s the coolest part—if we can put our different experiences together, we really can innovate solutions we never would have thought of had we stayed local. Many of the best solutions to the world’s largest problems will only come from that approach of cross-cultural, cross-disciplinary work, so jump into it!
In your opinion, what is the greatest struggle working women face today?
COVID has challenged all of us, but it’s been particularly hard on women, and the statistics show that. While many have become unemployed or underemployed during this pandemic, far more professional women have voluntarily left the workforce compared with men. The need to homeschool or coach little kids, find activities when everything has been cancelled, balance working from home without childcare options, and the inability to plan ahead have put a real strain on families. I know a lot of professional women who have had to cut back working just to make sure their kids would be cared for. As a society, we reacted to what was obviously in front of us (COVID), but failed to predict what lies beyond. It’s time to redesign. We’ve got to think about the long-term repercussions of our actions and how we can be more flexible to ensure we grow workforce diversity while also keeping people safe. PM