An Interview with Max Jordan Nguemeni Tiako, 4th year Medical Student

Max Jordan Nguemeni Tiako is a 4th year medical student at the Yale School of Medicine. He grew up in Yaoundé, Cameroon. He earned a B.S. in civil and environmental engineering from Howard University, and a Masters in Bioengineering from the Georgia Institute of Technology. He is the host of the podcast focusing on health disparities called “Flip the Script.”

1. Could you tell us a bit about yourself? 

I am a graduating medical student at Yale School of Medicine. I grew up in Yaoundé, Cameroon and moved to the United States in 2009 so I’ve been here almost 12 years. I first came to the United States to go to college. I attended Howard University for an undergraduate degree. Then, I moved to Atlanta to study at Georgia Tech, then worked for one year as a researcher at a lab at Vanderbilt. Eventually, I moved to New Haven to start medical school at Yale University. 

2. What are you passionate about? And what motivates you to keep going?

I’m really interested in research and how we can leverage research to improve policy. I am passionate about health equity. When I was in graduate school, I was in bioengineering, which is about developing new technologies for medical treatment and medical innovation. 

For me something that was glaringly apparent was that, as much as we as humans have come up with a lot of innovation in our world, a lot of those innovations haven’t help us close the life expectancy gap. If you look at the life expectancy gap between white and black people in the United States or globally between OECD countries and Sub-Saharan Africa countries, I realized  that there is a missing equity piece to a lot of the work that is done in terms of innovation and technology. 

One of my big interest is thinking about how we can further improve access to novel medication and more advanced therapy for people who continue to be disadvantage in terms of access. I am also often thinking about how social policies shape healthcare as an entity or medicine. Healthcare only shapes so much of one’s outcome, and there are so many social components that have an effect. For instance, we are in the era of climate change. Therefore, I am always thinking about how social policies end up burdening certain populations and disproportionately affect them. So, for my research now, I look at the quality of care received by people who have opiate use disorder. 

But I am also thinking about the environmental exposures, and whether certain environmental exposures are productive or toxic when you think about certain health outcomes. 

I am broadly interested in both the environment, and how it relates to health and its entanglement with social policy. 

3. Have you done research on the continent in Cameroon tailored to your interests?

All of my research at this point has been in the United States –  living here since I was 16 years old – before I knew what research was. Before moving to the United States, I lived in Cameroon, so I have a decent idea of what life is like there, and from just talking to family, from a healthcare perspective, we have a health system that is very much underdeveloped.

For instance, people show up to the emergency room and you might be dying and may not receive care. So that is one of the big issues I am aware of in terms the quality of care in Cameroon, and even the lack of access to certain diagnostic technologies – there are experts that cover this issue, and I am starting to investigate this issue.

However, in terms of energy and environmental policy, I feel like there’s an element of neoliberalism, which basically is as an outstretch of colonization that contributed to impeding the developments of these countries in terms of energy policy. For example, I remember that when I was younger living in Cameroon, the majority of the shares of our national energy or electricity company was bought by a US corporation, and they weren’t engaging. 

The reliance of private sector and the public-private partnerships were ultimately harming those who are least privilege in the society. 

Additionally, in terms of the environment and nature, I see it similarly. For example, malaria is one of the biggest killers and the leading cause of death in Cameroon alongside HIV. The spread of malaria has to do a lot with the environment like little pots of water near people’s houses; and trash piles – the company in charge of the trash is a private company that doesn’t do a good job with trash removal.

4.     How has your time at the Yale School of Medicine contribute to the work you are passionate about? 

I have had incredible mentors at Yale. My academic advisor is Dr. Marcella Nunez-Smith, who is now a co-chair of President Joe Biden’s Covid19 Taskforce. Just being under her tutelage in the Yale Medical School and getting guidance from her has very much inspired the kind of work that I want to do.

I am interested in the same kinds of things that Dr. Nunez-Smith is interested in  – she is doing work in the US, but also in the eastern Caribbean, the Virgin Islands, Trinidad, and Puerto Rico. Dr. Nunez-Smith focuses on chronic disease or non-communicable disease disparities as they relate to social-to-social determinants of health so she’s a huge influence and a mentor of mine. 

Additionally, Dr. Nunez-Smith is really interested in healthcare workforce diversity issues, so our interests are very much aligned. 

Also, the educational system at Yale has really allowed me to curate my experience and has been flexible to my needs in ways that I find unique to Yale.

In addition to the flexibility, there is just tremendous support for people who want to do research. For instance, I went to Penn to do research –  I did a lot of my work on opioid use disorder during prenatal care. I was able to go to another institution with Yale funding my research; and allowed me to have great mentor relationships during that time.

So that kind of support in terms of letting students pursue their own interest, I would say has very much shaped my educational experience.

There’s also an element of  receptiveness from the leadership – we’ve been able to make headway and address some of the gaps in the education system.  I was part of a big committee who evaluated the entire medical school curriculum – we presented recommendations and through the process were able to hire faculty to address some of the identified educational gaps. 

5. Why are doctors sometimes the targets of bias and racism? Can we fix this? And why does health and medical activism matter? 

That’s a really complex question that I am not sure I will be able to tackle entirely, but I think there are systemwide issues. To start with the medical school level, there are some issues there that have to do with race and class. For instance, the vast majority of medical students are coming from the top quintile of US household income and that comes with a set of bias. They often have had fewer interactions with low-income families, so class is at play here. But class is very much intertwined with race, so this means that the majority of medical students are also white. Because of the different experiences, there are biases that arise – for example black patients often get a late diagnosis of skin cancer, which has to do with access, health insurance, referrals, etc.

There are some ways to remedy this, but the first step has to be about diversifying the healthcare workforce, which starts with diversifying the medical school enrollment by lifting the barriers to entry that many non-white and low-income students face. Additionally, it’s important for medical schools to foster an environment that is pro-growth. An environment that is not only diverse and inclusive, but one that has mechanisms in place that address racist behavior. 

6. Can you tell us about why you created the “Flip the Script” podcast and how you see your work having an impact on medical education?

I started the podcast because I felt like there was a gap in our training and our education related to health inequities. I wanted to cover subject areas lacking and help close the gap, but it was important to do it in an accessible way, and podcasts are very accessible compared to other platforms. I listen to podcasts about a wide range of topics. So, I wanted to make one because I thought it would be fun, and I would learn in the process, and then share with the world what I learned when I interviewed people.

In terms of impact, it’s hard to measure the impact for a podcast. I don’t know whether people are changing their behavior after they’ve listened, but people have reached out to me and said I really liked that episode you did with Dorothy Roberts, and I am going to add it to my syllabus. I can’t tell you that my podcast is being incredibly impactful, but I know that it is reaching people that I didn’t think I could ever be able to reach. 

Additionally, I started this podcast in 2018 and since then, there have been a proliferation of podcasts that focus in one way or another on health and equity. I don’t think there was another podcast about health inequities before I started. I would like to think that I kind of grandfathered this movement for lack of a better word. 

7.  What are you looking forward to as you embark on your medical career?

I just got matched at Brigham and Women’s Hospital in Boston. I’m going to do internal medicine, and I’m looking forward to officially being in charge of people in the hospital. However, I am currently focused on finishing my last year and making the transition from being a medical student to being a first-year doctor. 

8. Any advice for young Africans considering going into the medical field? 

My advice is to be patient with yourself. There is always something that you didn’t know that maybe you should have known, and it is completely fine. 

Additionally, I would say value relationships that you have now and truly cultivate them. Try your best to stay in touch with people who have helped you get to where you are today. 

I would also add to always remember the reasons behind what you are doing. Whatever you’re doing, remember the reason and the motivation behind it because that really helps you especially if you are going into the medical field – do not let ego get in the way. For me, I would say I’m doing this because I want health equity and our health care system to be more equal both locally and globally. In the space of medicine there is glory that comes from your work. Never let that glory be the primary motivator behind what you are doing. You might end up at risk of doing the easy things that bring glory opposed to tackling the harder things that bring less glory but are more impactful.