An Inspiring Interview with Dr. Nidhi Khosla

Associate Professor of Public Health, Cal State East Bay

Recently, I had the incredible opportunity of speaking with Dr. Nidhi Khosla, an Associate Professor of Public Health at Cal State East Bay in Hayward. She has one of the most inspiring trajectories to academia that I have ever seen, full of urgency and humility to improve health disparities for vulnerable populations. 

Born and raised in India, Dr. Khosla’s initial academic plans did not include the United States. “I wanted to go to the United Kingdom to pursue a Masters in gender and development,” she told me. Instead, in 2005, she was selected as one of the recipients for the prestigious Rotary Peace Fellowship, which allowed her to pursue a Master in Public Health (MPH) degree, at UNC-Chapel Hill. Through dogged persistence, she he completed the requirements to study in the US despite the short time available..

But before she even touched down in the US, her experience was already impressive. For more than five years, she had been working in the not-for-profit sector in India, managing field programs in areas as diverse as HIV/AIDS, gender issues, water and sanitation, and disabilities. “The most immediate thing that spoke to me was women's health and how they face health disparities,” she told me. She arrived in the US thinking that a degree in gender and development was what she wanted to pursue, but the MPH program helped her refine her focus to women’s health overall, within a broader encompassing view of public health. In her second year, Dr. Khosla found herself drawn towards research in particular, within South Asian populations, and eventually started thinking about a PhD. She applied to Harvard, Johns Hopkins, Columbia, and UNC Chapel Hill. It was a high-risk strategy to focus only on top schools and she got into all four. All four offered her funding. “Harvard made me a great offer, so did Hopkins , but Hopkins had a much more extensive program in South Asia than Harvard did.” So, she ended up choosing Hopkins.

At Johns Hopkins, she was able to conduct research as a student research assistant for CDC related to HIV risk factors. Through her research, she discovered her dissertation topic: “I exclaimed to [my advisor], I said, I don't understand why the situation in Baltimore is so bad when we have so many resources for HIV prevention. And he said, ‘Well, that could be your dissertation topic.’” So she shifted her work from epidemiological research to organizational behavior. While finishing her dissertation, she accepted a tenure–track position at the University of Missouri, Columbia. She worked there for four years, but wanted to move to a more diverse area, so she moved to California and has been a professor at Cal State East Bay since 2016. 

Today, Dr. Khosla focuses her research on improving access to care for vulnerable populations and reducing health disparities. She has studied end-of-life care among South Asians, HIV prevention, and advance care planning. “Vulnerable populations” is an idea that Dr. Khosla uses as an umbrella term. The term vulnerable populations “refers to different populations that are at risk for adverse health outcomes.” A unifying thread in Khosla's work has been the fact that the populations she studies have been vulnerable for different reasons. One particularly striking finding she’s identified through her work on palliative care has to do with end-of-life care specifically, and the model minority stereotype surrounding South Asians in the United States more generally. She talked about how cultural values and ways of life in South Asia are not accustomed to machine-oriented healthcare or even talking about advance care planning. “We have phrases in Hindi such as “shubh shubh bolo”, which means to say auspicious things,” she noted. She talked about how physicians in the United States can get confused when dealing with South Asian families, giving this example: “Let's say a patient is hospitalized and the physician meets a young man who's introduced as the patient's son. Well, it's not actually the patient's son, it's the nephew of the friend of the patient. But because we like to, you know, make these honorary family relationships, it gets really confusing for physicians.” 

A lot of Dr Khosla's work examines the way cultural realities collide with healthcare when it comes to end-of-life care. For instance, she found that family-based decision making is a very strong belief in South Asian culture. She determined that, “It is important to identify a spokesperson early on, so that when the care team is communicating with the patient or family they know which individual to speak to.” There is also a cultural hesitation towards pain medication in South Asians cultures that comes from the belief in karma. This is to say that many South Asians believe that whatever a person feels right now is a result of their past actions in this life or a previous one. “And so, if pain is happening it's a result of karma, and such should be borne, instead of being extinguished using pain killers.” As a result, Dr. Khosla serves on the research committee for Pallium India USA, a palliative care organization in India. They are trying to advocate for the availability of painkillers or other palliative services. “All of this gets into issues that physicians and other health care providers here need to know about.”

She then spoke about some challenges with end of life care. One major issue she brought up was having trust in the medical system, due to problems such as racism, whether it be intentional or not. The racism might be an effect of the cultural differences people face, especially in melting pots in the United States such as the Bay Area in California where Dr. Khosla is currently based. She also talked about hospice, and how even though it is common in the United States, it is almost like a “bad word,” according to some youth, in South Asian communities. She also talked about the notion of seva (selfless service) and the filial obligation of a young person to return the service to their parents. “Providing care for your parents and especially providing it yourself instead of hired help is considered part of the seva that you're supposed to do for your family,” she said.

Now, I want to include a small blurb about Dr. Khosla’s vision for the future of public health: “I think the future is bright, there is a lot more awareness about public health change for example because people are experiencing it in their lives. Young people are much more aware through social media about what's happening. And, especially in Bay Area communities I think there is more motivation for collective action in addressing these health inequities. There's a lot more that needs to be done. I think most individuals are affected by what's happening in their immediate ecology in terms of things like what's happening in their immediate families or their immediate neighborhoods. So to get them to think beyond that could be a little difficult. But I'm sure that expanding opportunities for young people would really help in creating a space that's more socially conscious. You know, a group that’s aware of racism and other structural inequalities in society, and is more willing to address those things. So I think that's what I have to say.”