Do the Change with Sangeeta Agarawal

Part 1: Do the Change with Sangeeta Agarawal

JOANNE TEH: Hey guys, welcome to Do The Change podcast where we're challenging and reimagining Occupational and Environmental Health Sciences. In this podcast, we focus on upcoming and current leaders in their field and dive into how they got to where they are today, and their advice for those interested in the field. My name is Joanne Teh and I'm a current undergraduate here at Berkeley. And our guest for this episode is Sangeeta Agarawal.

SANGEETA AGARAWAL: Hey everyone! Thank you for being here.

JOANNE TEH: Thanks for joining us. So Sangeeta Agarawal or San for short is a computer, an AI engineer who is an integrative medicine clinician. She's passionate about quality of life for people undergoing serious health conditions and for workers in relation to Total Worker Health. In the past she's worked in developing digital health technologies, founding a company that empowered people going through cancer and other short-term disabilities by providing a combination of high-tech and high touch solutions. This company built the first digital AI nurse for symptom management and navigation called San and currently continues her research in this field as she graduates with her MP in occupational health and is moving forward to starting her PhD with the UC Occupational Health and Nursing department. So, nice to meet you San.

SANGEETA AGARAWAL: Thank you Joanne for having me here. So nice to meet you too and it's truly a privilege to be here and I hope I can add value to our listeners.

JOANNE TEH: Definitely, I think you have a really cool story so I don't doubt it at all. So speaking of would you like to like kind of go into like how you- my most, my top question for you when I learned about you was how you went from Tech to nursing to occupational health. So, yeah it's quite this sequence, so would you like to tell us a little bit about that?

SANGEETA AGARAWAL: Yeah, it is quite a journey. So I was, when I was growing up my great grandfather was a Vaidya, an Indian medicine doctor. So the very first thing I learned was Healthcare and taking care of people and that's something that you know I became passionate about from very early on. After that I had a rough childhood so I almost grew up on the streets, you know pretty much depending on charity and public health system for supporting me. I ended up you know being a complete nerd and being scrappy and finding my way through life including like giving my own name, going to school, giving my own name, studying by street lights and you know finding my path forward um and I did a career in Tech, came to U.S. and then I ended up building after working in some tech companies I ended up building video streaming on phone which got acquired by Skype giving rise to Skype Mobile.

JOANNE TEH: Wow.

SANGEETA AGARAWAL: Thank you so it gave me an opportunity at that time to pause and think about what I want to do in my life it was also about the time that I had just got married to the love of my life and he was super supportive or he continues to be super supportive and he was like just go do what makes you happy, you know? It's fine.

JOANNE TEH: So sweet.

SANGEETA AGARAWAL: Yeah so, so I did. I went and be who I wanted to be. And I decided to pursue a career in healthcare and part of what was happening around that time was I had been through a very difficult disability in my life. A very difficult health challenge, physical and mental, and I needed some time off to you know recover. But I knew nothing about disability or anything and I was on Visa and it so happened that because I got married I could take time off, but otherwise I didn't know how I could have possibly taken time off so that really made me feel that there is this really precarious aspect of you could lose everything that you worked hard for if you suddenly get sick, because everything is you know your insurance your employment your Visa status could be tied to your work, so that's something that was always at the back of my mind, and then as I worked on recovering my own health I felt like you know I want to devote the rest of my life to empowering other people to have the quality of life that they want and my husband Shaunak was super supportive about it so I pursued career in both eastern and western medicines.

I went back to my Eastern roots and trained at the highest level in that area, becoming a clinical Ayurveda practitioner and yoga practitioner and continue to run a small nonprofit kind of clinic supporting people in the community in that space and also from a research perspective doing at NCI doing review of integrative medicine research and then on the nursing side I pursued career in nursing and became a cancer nurse, mostly focused on symptom management and navigation for cancer patients and helping them through their journey. In the last five years or like 2015/2016 onwards like after I had done some research in this area and saw the combination of how whole health and you know like a structured program can support people with having great outcomes had done that research at UC. I felt like if I could make this available to a large number of people in the community then that can help many many people who are going through cancer and other short-term disabilities.

So UC was really supportive, I was working at UC at that time and I went through all the different entrepreneurship program and I was in UC skydeck so I worked on building that company from ground up, you know, hands on and everything and then ended up you know, working through and supporting a lot of people going through this, so helped over 27,000 people going through cancer and worked with disability carriers and worked on changing some of the paradigm and awareness about this. At the same time some of the challenges I was facing was that what I was seeing the problem people had was that they were stuck between this rock and a hard place where they needed to take time off for treatment, they were going through a lot of you know health problems, side effects, complications, that is kind of you know part of going through a serious illness but at the same time their insurance was tied to work and they felt all this you know this whole struggle between working and and getting treatment. So I felt like there was this very strong connection between employ- between Occupational Health aspect and serious illnesses.

And then on the other hand in my clinic what I was seeing was that lot of muscularskeletal and lot of day to-day health challenges like even mental health and stress and all of that was related to work because people are spending the whole day there, right? So that got me interested in the Occupational Health piece and I feel like I wanted to understand that field more in depth and be able to help people to live well and work well and be healthy. And around the same time, you know logistically from a business perspective there was, it was getting complicated during covid to keep the company running with the kind of contracts that we had, so I felt like the best way I could continue the work forward and serve people was to actually do my nurse practitioner degree and PhD in this area, because as a nurse practitioner, I would be able to help people in the community hands-on as a clinician and they can use, people can use their insurance to come and see me.

And from the technology perspective, like the kind of work I was doing was so much at the cutting edge that either I needed to raise a lot of money to build those technologies or I needed to do it as a research, you know from a research perspective so NCI was you know NCI program managers were very kind to kind of guide me in that direction. They're like you know how about think of doing it as a research, it's so cutting edge. So that's how I found my way here and I hope I can continue to do good things with serving people and with making contribution and difference in the community.

JOANNE TEH: That's awesome, wow. At first I was surprised because it sounded like this sequence of like fields was kind of like how did you manage to go through these three fields? But after you explain it and like how it was just like a natural consequence of like following your personal passions in these fields it makes so much sense.

SANGEETA AGARAWAL: Yeah thank you I love empowering people to be able to do what they want in life because in my life I wanted to have, I wanted to be able to have a say over what my destiny is and what my life will be whether you know I grew up on the streets in India or grew up as you know as a girl child in a very traditional part of India or I went through you know like these really horrible disabling situations and you know, I would have in all of these if I just let the situation take over I would have felt helpless and my destiny would have been different, but I found you know a way to lift myself up and do and carve my own destiny with the help of people and resources in the community and that's what I want to offer people or that's what I continue to offer people through my work and that's what I'm really passionate about is helping people to feel they still have the power even when life is going wrong and even when things are falling apart and it's chaotic.

JOANNE TEH: That's so admirable did you ever have like moments of doubt as you're going through these different like career changes and like following your passion because that's like the hard part right like feeling doubt as you're trying to follow your passion?

SANGEETA AGARAWAL: Yeah. Oh, yeah I mean I wouldn't, it's not so much doubt I just felt like I was really, I felt critical of myself.

JOANNE TEH: Ah, I see.

SANGEETA AGARAWAL: Because of the uncertainty. It's like you know, I could have a a really good stable career as a computer engineer.

JOANNE TEH: Yeah, you mentioned Skype Mobile like that's amazing.

SANGEETA AGARAWAL: I could have done that, but I changed careers, spent years learning, and then I went into healthcare and then I was working in healthcare and now I'm like no I want to be able to serve more people and be able to do more for you know for contributing to the area. And then I go and you know try these new things and I went through, I go through all these struggles and challenges and failures and ups and downs and you know kind of re what feels like restarting my career a bunch of times. So through all of that, I'm like why do I have this itch? You know, this craziness to to do all these things instead of like having a good stable job and you know growing in that and being happy, so that's kind of what I've struggled with many times. But I just find that I've embraced my nerdiness at this point.

This is, this is just who I am I know I want to be able to continue to contribute and make a difference so I'll keep finding ways to do that, yeah I think it's the uncertainty that makes it hard, but I also feel that you know we have one life and if you feel that you have something that's calling you and that you're meant to do or that you're really passionate about and you see that problem that's bigger than you, then no matter like the probability of success in that area, I feel like it's worthwhile to pursue that and to work on making that difference.

Because even if I go till so far you know, even if I don't reach my end goal of 100% but even if I reach 30 40% or whoever is pursuing like even if you make some progress you worked towards an arc of progress and there will be, it'll create this momentum and energy where other people will you know be inspired and think that's a good idea and try to work on it, replicate it, grow it, do it their own way and soon that can create this arc, this momentum, that can cause this change towards what you, you know what you hoped to achieve right how you see the world as a better place you can actually make that happen.

So that's why I feel like it's it's worth pursuing that, you know, like in my own life, I come like I mentioned I come from a very traditional background so in my community girls got you know, women like they got engaged when they were 16 and got married at 18. They were not allowed to study or work but I believed that I, you know I wanted to be able to do things on my own and I did I just went to school on my own and registered myself.

JOANNE TEH: Oh my goodness.

SANGEETA AGARAWAL: And studied by through school lights I mean street lights, and then when it came time to work I did that and when it came time to pursuing higher degree and coming to U.S., nobody in my family had done that and in fact people were against it. I faced lot of push backs I was literally on the streets, but I believe that could make a difference and if I succeeded in this it could it will help me to live the life that I want but it will also open up pathways for other people which is what it did because after I had worked after I came to U.S., I studied I worked and you know my relatives saw that I'm alive and I'm well and nothing like you know that they were afraid happened to me.

All my cousins after this have had opportunities to pursue their career right so I feel like it's worth pursuing even if there is hardship even if you have some setbacks and failure and somebody else carries the work forward I think it's worth it. And same with my Tech Career I you know when I built the technology it was because I saw really horrible things happen to people and I feel like if they had a way that they could just push a button on their phone and show what was actually happening to them instead of somebody else's narrative of what was happening in the situation that would empower them and by building this technology like early on in 2000s it did that, today you know people use video and live streaming all the time, you know FaceTime. It's a reality today.

JOANNE TEH: That's awesome, wow, oh my goodness. That's really inspiring actually. I'm gonna have to like reflect on myself after this. I wanted to ask you it's like when times we tough like what things did you do or things did you turn to in order to like make yourself see like the light at the end the tunnel, to remind yourself like why you're doing this, how did you push through?

SANGEETA AGARAWAL: I think you actually answered the question in the question because like you said it's about you remind yourself why are you doing it.

JOANNE TEH: I see yeah.

SANGEETA AGARAWAL: Yeah. That's what matters and I feel like even if you know it's kind of like do or die, so even if I fail trying, if the goal is so important if it's big enough then it's worth it, you know that's that's just how I see it and I think the other thing is sometimes with hard situations it's like the only way is through. So you hang in there and you drag things to the finish line or you drag yourself to the finish line because you just need to, you know? You just want to get there and you just work through whatever needs to be worked through to get there whether that's you know 10 issues in 10 different areas or you know 200 issues in 200 different areas you just, you know keep working through it till you get to that finish line or you know till you get to wherever you need to be.

JOANNE TEH: Mhm.

SANGEETA AGARAWAL: Yes I think that helps me and daily practices like self-care practices I think those are huge, for me that's what keeps me grounded so I-

JOANNE TEH: What you personally practice? Sorry.

SANGEETA AGARAWAL: Yeah, yeah, yeah. Actually that's perfect that's exactly what I was gonna get into. Yeah, so I do daily Kriya and meditation. Kriya is like a breathing technique. So I do daily Kriya meditation, I do daily workout whether that's a short home workout or I go to um to a workout class so I do that every day and then the one thing that I found really helpful once I added to my life was planning so one of my friend introduced me to this initially it's a planning in in like the different areas of your life we did it as a new year exercise I think one time. So planning in like the main areas of your life I think it's like seven areas or something so, so making your plan in those areas like what is it that you want to, where are you today, how do you feel about it, and then where do you want to be.

So you have that plan whether that's you know annual you can do like a longer term 5 year/10 year plan, and then from that I break it down into a quarterly plan so I do that every quarter, I have a plan for what I hope to accomplish is generally pretty aggressive so there some some percentage of it, and then from that I make the monthly and weekly so you know I just kind of work my way backwards looking at those goals and then I will make my plan for the week in those areas, so every day and then from that every day.

So I journal every every day so I'll plan okay this is what I'm going to do today and then I check did I work on that. And then every day I journal what I accomplished and what I want to improve and what I'm grateful for, so those are things that I do every day. Plus I want to share one more thing which is that I would say I would call myself a modern Yogi, so I follow yoga not just from like the asana perspective but from the scripture perspective.

So Patanjali Yoga Sutra so I follow the teachings of that and that has yamas and niyamas which are basically principles so Patanjali was a scientist who gives you this scientific book in a way like from a holistic perspective scientific book on how to live life well. How to live life in harmony so it has principles that internal disciplines and external disciplines, so I journal on that every day and that's how I catch myself if I went off track on something so yeah so those are part of my practices on a daily basis that keeps me really grounded.

JOANNE TEH: I really like the method of planning that you mentioned like starting from your big picture goals and going smaller, working backwards that means like you're for sure going to keep your main goal in mind. I think it's easy because I will often do my I will usually do my planning day by day because that's just like what's convenient like Google Calendar shows me the week in advance but then I forget like what I'm actually working towards.

SANGEETA AGARAWAL: Yeah, yeah. I forget too and that's why I have to remind myself, you know.

JOANNE TEH: Mhm. That's awesome.

SANGEETA AGARAWAL: And I have like reminders in different places like stuck on the different walls and by my bathroom mirror with like that's what you're working towards in case you've forgotten.

JOANNE TEH: That's awesome, okay. Then how about we pivot or actually wait before we pivot to asking you about your Occupational Health, your work in Occupational Health, I wanted to ask you like so your app it's or is it an app?

SANGEETA AGARAWAL: Yeah, yeah. So that company I ended up having to wrap it up.

JOANNE TEH: Ahh.

SANGEETA AGARAWAL: But yes it was an app it was a health-c app and it had a combination of high-tech and high touch so it had a AI nurse and a digital Health platform that navigated people through different symptoms and different issues and then there was also a clinical team, a interdisciplinary clinical team that was involved in the care of patients. So the combination of the two worked in providing care to people and enabling them to be able to go through these difficult illnesses, you know, yeah so that's what it was doing the challenge with that was the business model because as you know digital health is not reimbursed so building all that technology it was difficult to actually get reimbursed for those technologies and then it required a lot of Business Development and sales which was also expensive and the operating cost of that.

So that was some of the challenge there and because I was myself not directly a practitione I couldn't, I had to work under the license of other providers so that's where I felt that if I am a practitioner then I can work alongside a physician but I can provide care and it can be reimbursed by insurance and the kind of technologies I was building, some of those were getting into like really cutting edge stuff so I wanted to build them in a very systematic focused way so that it's safe for patients before we make it accessible, you know because once you put a tech out there and it's available to people you don't know what might be the health condition of someone who's accessing it. So I wanted to make sure that before I commercialize you know these AI chatbots and nurse- and and symptom management technologies, they were well tested so that's where I felt that it's better to actually roll it back and pursue it from a research perspective.

JOANNE TEH: I see so that's what led you to like currently going back to school doing all these programs, I see.

SANGEETA AGARAWAL: Yeah.
JOANNE TEH: Interesting.

SANGEETA AGARAWAL: Yeah. So if I did my research correctly you did your, you got your RN from UCSF is that correct? I got my RN in 2012 from Samuel Meritt and I'm getting my nurse practitioner in Occupational Health now at UCSF.

JOANNE TEH: Oh I see there we go.

SANGEETA AGARAWAL: Yeah, yeah. And we take classes with both the UCSF Occupational and Med and we take classes with the UC Berkeley Public Health Department so with Dr Clarissa Harris and other people in public health as well and then I'm going to continue on with my PhD from this combo of UCSF, UC Berkeley in Occupational Health.

JOANNE TEH: I see, I see, so how do you like it so far?

SANGEETA AGARAWAL: I love it, I love it. I feel like I came for for the clinical or the learning or the topics on my checklist, you know, it went from head to heart because I just feel like I found the community where I feel at home where I feel like I belong and it just, it just feels comfortable and it's inspiring it's comfortable and inspiring at the same time like I feel that I belong here, I feel safe, I feel accepted, I feel like there is a lot of diversity and there is acceptance of diversity and at the same time people are so freaking brilliant and they're so passionate about their field and they find ways to make a difference, you know despite all the challenges and push backs and working through years in fact decades and decades on whatever topic they're passionate about.

And I feel like that's how I feel and that's how I am so I felt like a misfit for many years and here I just feel like I found my community and I found my people so I absolutely love it. It gives me all the intellectual, more than enough intellectual stimulation that I need. It gives me direction, I have amazing mentors and teachers and I get so much love and support, I can't see myself not being part of it.

JOANNE TEH: That's awesome, wow so that's why you're committing to a full PhD in Occupational Health hmm, yeah.

SANGEETA AGARAWAL: Yeah.
JOANNE TEH: Where are you currently researching?

SANGEETA AGARAWAL: Yeah. So my plan is to work as a nurse practitioner and do my research, so do my PhD so I want to be a clinician who's working and seeing people in the field and seeing real problems and working on those in my research and kind of it's a feedback loop.

JOANNE TEH: Ahh.

SANGEETA AGARAWAL: Where I can improve care, yeah. So for your question, sorry I interrupted you, about what am I what my research, what is my research area, so my research area is at the intersection of cancer treatment and leave management so people who are working and just got diagnosed with cancer I'm starting with breast cancer, so people are diagnosed with breast cancer so they need treatment they need time off, the treatment tends to be you know anything between 6 months to 18 months long, but the leave typically like short-term disable, the FMLA is just 3 months and then people can get short-term disability, you know who have that eligibility but others don't so there is just this whole challenge between the treatment and the need for time off, for the treatment and managing the side effects and you know managing your health and at the same time, the commitment towards being at work and the risk of losing you know your job like not having that protection at work.

So that's the intersection that I'm looking at currently what are the problems in that area who is working on it, what is being currently done, where the gaps are and then what can be done to support people who are undergoing active treatment, employees, you know people who are working who are going through active treatment and need you know support and programs that are designed for it, so that's the area I'm interested in working on that's the area I'm working on. And my goal is to understand this in more depth and then be able to develop solutions to address it, incorporating my background in in eastern and western medicine so provide that whole health approach and technology for it, yeah.

JOANNE TEH: Mhm, wow. That's really cool. How's the journey going so far like is have you been able to start working towards that?

SANGEETA AGARAWAL: Yeah I have it's it's really going amazing I have like amazing like a, you know the community is just so awesome with people who are passionate about it and who can you know connect you to other people who are passionate about it. So, yeah so I started to research on this topic even in my nurse practitioner program it's part of my class projects and Dr. Soo-Jeong Lee and Dr. Hong who are the two main professors in the Occupational Health nursing department, they were very supportive and I was able to do a poster presentation at the Occupational Medicine conference last year on this topic when I was just starting out my Master's Degree.

And then this year I continued to go deeper into it and worked on this topic for my comp paper so I reviewed researched papers in this area all the papers in that area and I presented at the Occupational Health conference then I've interviewed Healthcare professionals who are working with this population and seeing what they are finding or what the processes are and that I'm presenting next week at the oncology nursing Society, the annual conference because I want other oncology nurses to know about this and learn what they are doing what's happening in their institution and hear their thoughts on it, what could be done.

And I'm part of an IRB at Kaiser on this topic where I'm doing research on this area and looking at actual patient charts so I have like really amazing mentors to support me in this Dr. Lou at Kaiser allowed me, he's a PI, he's allowed me to be part of his research and then my advisor Dr Hong, Dr Lee, have been helping me with learning how to navigate research and then one of the one person who was really instrumental for me when I started out was actually one of the Emeritus from the program Emeritus faculty Dr Barbara Burgel, she had, she talked in some of the events and I reached out to her and shared with her my passion and she was very supportive and responsive and she's kind of being my mentor when I started out and it kind of supported me through my tons of ideas and directing me and helping me to be excited about it.

So she's been amazing and the seniors have also been super supportive, one of the senior Dory she became my peer Mentor and she's helped me to see what the path can look like a year ahead and how she's thinking about the field, so it's really really cool.

JOANNE TEH: Awesome, a few things one good luck on your presentation next week.

SANGEETA AGARAWAL: Thank you.

JOANNE TEH: And two, it sounds like you found a lot of good mentors via like your own personal like reaching out to them or like it just seems like you've been able to land yourself many good mentors so do you have any tips for people who are like young professionals trying to look for mentors in your field?

SANGEETA AGARAWAL: Yeah I mean, I would say first of all, I would say that think about what is it that you want to accomplish. You know, so think about what is your goals and what you can do, like the way I think about it is what can I do I want to I want to do ABC and then what can I do about it right now, what can I research online about it what programs or you know where can I gather the information about it, and how far can I get? And then I figured out what are the places I got stuck, what are the questions that I have that are you know like this not that I can't solve or you know something that I don't know what to expect or do I have a solid understanding, like you know a soundboard for what is it that I want to validate with somebody.

So once I know what exactly I want then I try to figure out who are the people who have already done this? These are the people who have walked the path so they know answers to the kind of things that I'm trying to work on, right? So then I try to identify those people and I think being part of a great community is that difference you know UC has one of the most incredible communities that is very open and supportive. I know that if I send a message generally people will respond back from my UC email, if not the first one by the third time people respond. And I do the same you know if somebody reaches out to me for guidance or support I will you know at least direct them in the right, you know in in a particular way to help them with their goal.

So I would say like figure out you know what is it you want who are the people and then among those people who can be in your network that you can either reach out to directly because you know them or someone you know knows them you know LinkedIn is a great place because you may know so many people, or they may know the person that you want to know and you see email is connected to LinkedIn, so you can search somebody's name you can search the LinkedIn, so usually either through the direct email or LinkedIn you find somebody and you know get connected to people.

So that's how I do it and then when I message that person I give them a little intro about you know my background like a very short blurb, one or two lines and then I tell them exactly what I'm looking for and many times it's sometimes either a quick answer from them where it might be like a short email they have to reply back or they can direct me to a resource or it might be that you know I want a quick call and, or they might suggest well why don't I do a quick call with you so that's how I generally do it and then I make sure that I thank that person for their time and if I can do something to help them with their goals I try to do that sometimes that's simple like you know they may want to be connected to somebody, something you know or they goal is something and like oh I know this person who can help them or this particular thing might help them so, so I just try to do something that could help them or another great way is to to write a nice review for them you know like either you can write a nice review on LinkedIn or just send their supervisor a nice note saying this person went above and beyond to help me even if they didn't have to so I really appreciate it and that's a nice way for them to get you know appreciated for the work that they're doing to help you beyond their day-to-day job.

JOANNE TEH: Mhm wow. It's like you read my mind as you were explaining like your tips I was thinking myself like the next thing I was going to ask you is like a lot of people who are like my age undergrads, newly graduated students I feel like the thing that they struggle a lot with when it comes to networking is like not feeling like a leech quote unquote like making sure that they I don't know can help their Mentor in some way so that it's not just like fully one-sided, but yeah those are great tips.

SANGEETA AGARAWAL: Yeah, I feel like mentors like being able to see somebody you know reach their goal and flourish in that, like I know I do when I Mentor students and when I Mentor nurses or recept nurses in whatever role, right? It makes, it gives me joy to see that this is something that they wanted to accomplish and now they're very grounded in it and they're like yeah I got this you know. So I think one way to thank them is to actually keep them updated about your progress and say look this helped me and now I'm, you know what I accomplished that goal and I'm now working on ABC so that itself is very gratifying.

JOANNE TEH: Wow that's a really nice perspective. I don't often hear like the perspective of the mentor so that's really awesome, actually.

JOANNE TEH: Hey guys this is Joanne, your host for this episode and we have reached the end of part one of this conversation with our wonderful guest. Don't click out yet because part two of this conversation has already been posted, so check out our page to finish the conversation. Don't forget to subscribe to our YouTube channel and follow us on Spotify and Instagram @dothechangepodcast.

Part 2: Do the Change with Sangeeta Agarawal

JOANNE TEH: Hi everyone welcome back to part two of our conversation with our amazing speaker on the Do the Change podcast. We're going to jump right back into the conversation, don't forget to subscribe to our YouTube and follow us on Spotify and Instagram @dothechangepodcast.

JOANNE TEH: Okay, in that case let me see, maybe we can pivot a little bit and let me ask you like I guess like in terms of advice for new professionals new people, people who are new to the field of Occupational Health do you let me see do you have any like advice that you wish someone had given you when you had first, when you are currently joining this field or when you first started off your professional career?

SANGEETA AGARAWAL: Do you mean as a nurse or in occupational health because I'm starting out in occupational-

JOANNE TEH: Well yeah, in terms of starting out in Occupational Health is there any like or is there anything you're currently struggling with that you would like to tell people about or if you have any advice for your previous fields or you just starting out as a professional starting out your professional career?

SANGEETA AGARAWAL: Okay so maybe let's take those up as two separate questions so first of all I think the field of Occupational Health and nursing could use marketing because it's such an incredible field, we you know a lot of people that we see unless we are seeing you know people who are retired and that's awesome you know unless you're working with that geratology population, most of people today are working, so the whole occupational field some is something that is such a core part of you know of of the day-to-day life of people that we care for and it has such a huge influence on their health both in terms of how it affects them and then how they can influene their environment to be able to live healthy or address the challenges and even for people who are retired, I mean many people have injuries or you know conditions that they may be struggling for that could have resulted from you know their, the kind of issues that they faced at work whether that was bad posture or you know toxins or whatever.

So I would say first of all I wish more people knew about this field because it is such a cool field and I feel like I can apply that knowledge no matter what field you go in whether you go into primary care you go into speciality care you go into urgent care as a nurse, as a nurse practitioner this field is so very applicable so I hope that more people are able to know about it and you know do continuing ed classes or do some form of learning in this field to know about it and be able to apply it like things like ergonomics and biomechanics, we can use that to help people. So that's the first thing I would say is I haven't seen that before and I would like to support in marketing about it and another point from a marketing perspective is at UCSF there, I was very fortunate I got NIOSH scholarship, a NIOSH trainee scholarship so part of my tuition was covered by that so not only did I get all this additional training and learning it also paid for part of my tuition I got, so I got the double the benefit about it.

So I would say that's one thing secondly, this area of Occupational Health like when I went into it I didn't realize that it's such a beautiful community and there are all these additional classes and people and all of that so that took me a while to understand the difference between the reg- the main adult gerentology program that I'm part of in that umbrella and then the Occupational Health piece, so if somebody is working or you know has a lot of other commitments it can feel overwhelming to have all these extra like classes, grant rounds, events, research things and all the stuff that is part of you know part of this package.

So if you're going into the field or you know going into this program understand the expectations and the course load so that you can plan your life accordingly and then I would say really take advantage of all the opportunities that you can because like once I kind of settled into it I feel like I was meeting people who literally wrote the textbooks, you know they wrote the textbooks on toxicology they identified the very first issues and fought for advocating for those rights or you know fought for those restrictions, you know like people who are really eminent in the field who are being the groundbreaking people in the field who are really made changes in the field.

So really embrace being part of this community and feeling that yes I can learn and these are my, you know this is my community, it took me a while to get into that and to not have a impostor syndrome because I was like what am I doing here with all these people, but at some point I said you know this this is something I'm passionate about and I don't need to have made all the amazing accomplishments that they have, it's fine because I'm a student and my job right now is to learn from them and then figure out what I'll do in the future so really embracing that community and those relationships I think can go a very long way.

JOANNE TEH: That's really good advice, yeah taking advantage of the community that you're currently in whether or not you personally feel like you are a part of it yet, which you are.

SANGEETA AGARAWAL: Yeah, yeah, so yeah exactly, exactly. So I would say for occupational health I would say that for nursing, I've been a nurse for 12 years now and thinking of advice, I think one advice that I have learned to give myself now because as I'm looking at career opportunities and where I want to go next is earlier I used to look at where I'm going to go next based on a checklist of I hope it has these objective things, what I've learned about myself in the last few decades of working is that if I have a supportive environment and the cultural fit I really thrive. And if the culture or the job is not set up for success then you know even if you survive it's a very stressful environment so I would say that you know as much as I believe in not giving up I also believe in choosing yourself, choosing the quality of your own life, what you want and then finding the right places, the right people, the right community to work in so that you feel good about being there and working there.

So I think that would be one of my biggest takeaways and secondly if you want to accomplish something or you feel like one day I want to do ABC, get started now you know reach out to people who are doing that work and say let me learn with you or let me try it and watch over what I'm doing because you can get there sooner than you think and I was very fortunate even when I was you know, when I became a cancer nurse I had all these ideas about Integrative Medicine applying, you know evidence-based Integrative Medicine in cancer and while I was in nursing school I reached out to people and I ended up being being on this research project where I ended up you know working on the actual manual for writing it and I ended up you know being part of the oncology nursing society community in integrative medicine and then becoming a chair for the integrative medicine community.

So like a lot of things like that it's just, you know just show up and start working on your dreams now and as you work on it you will find the path forward.

JOANNE TEH: Wow that's really good advice you mentioned the thing about you previously saw your check- your like future goals as like a objective checklist of things that you wanted and I realized that's currently me and I have some self-reflection to do.

SANGEETA AGARAWAL: Yeah, and it evolves right? As you work on your goals you're like yeah, maybe I need to change this one. So, but then you know and you can change it anytime you want but you're working on what you want to be working on consciously.

JOANNE TEH: Wow.

SANGEETA AGARAWAL: And feeling joy in what you're doing because you're like I'm not in this situation because somebody forced me to be in this situation. I'm here because I want to be here, you know there's a difference between saying oh my god I have to go to school and you know have classes from like 8 in the morning till 5:00 and I have to come back and work on my homework till 10:00 at night or there's a difference in saying you know, I actually want to learn this topic and I want to be a clinician in this area and I'm learning with these super smart people you know with a content that is so well designed, one of the best in the world and I get to be in that environment where I get to learn from these people in a very structured way and have the day to be able to do that. And that completely changes the way you look at the day, you approach the day and how you absorb you know the knowledge and how you feel internally about yourself, you know?

JOANNE TEH: Wow. Wow.

SANGEETA AGARAWAL: That's just what works for me, you know I'm just sharing with you what works for me.

JOANNE TEH: Uhuh. Dang I will be up tonight in bed thinking about this. Okay, in that case well, okay there's one thing I want to talk about for sure before we pivot a bit.

SANGEETA AGARAWAL: Yeah.

JOANNE TEH: That we mentioned earlier before we started this recording which was your work in space nursing, like I really want to know about that, that sounds awesome.

SANGEETA AGARAWAL: Yeah, so that kind of comes for me in the area of future of work and future of healthcare, so when I think about how you know from an evolution perspective work is evolving too. You know, the kind of work that we were that people were doing 50 years ago is very different than the work we are doing now and the kind of work that people will be doing 50 years from now or even 10 years from now might be quite different, you know? So as we look at helping people have quality of life both at home and at work it's important to think about how the actual job is evolving you know what are the kind of jobs that people are doing for example like earlier there was you know not earlier but still there is a lot of like unions and regulations and laws but so much of the workforce is going towards gig economy, gig economy has been growing exponentially right so what happens to people who are in that space from their healthcare perspective? What happens from, what happens to people who are working in innovate you know at Innovative Technologies, you know whether that is they're working in robotics or they're working you know Uber drivers right, or Airbnb or instacart or whatever right like delivering groceries, it's a whole new set of Health Care, Occupational Health assessment to consider and applying that to the field of you know space Health you know in few decades from now we will be looking at you know having interplanetary human communities so that means there will be people who are working you know on other planets or you know on moon and all of this is becoming real, right, the technology, the AI, all of this is becoming very very real in the last few years right?

So my goal is to be able to understand how things are changing in healthcare both in terms of how all this innovation impact humans and what can be done to assess and understand and support that and secondly how we can use technology in a healthy way in a way that it helps humanity and how do we you know look at the checks and bounds that are, that technology or technology related organizations need to have so that things can move in a direction that supports Humanity. So that's kind of like the the broader overarching viewpoint that I look at.

From a space health perspective it's something that I've always been passionate about like the whole space world and it was a hobby or you know it was just something internally in me like I kind of have these dreams or visions if you will of you know what the future of humanity can be and up to a certain point I thought this is all like you know it's sci-fi, and I watched like almost all Sci-Fi movies but then I actually started to see how there is an intersection between something like space travel and serious health illnesses. Remember like we talked about earlier cancer and other serious health illnesses, so serious health illnesses is a person got diagnosed with that problem and now they have the serious health illness. With space health, the environment creates such a big change in your health that you end up with a serious health illness or with the environment that has that, so you need a similar kind of complex Care Management to address this whole multifaceted whole health approach to addressing that human being, you know? And that's where I think there's such an interesting intersection of Healthcare and technology and space health so that's something that I started to realize it's it's actually kind of real and then and I started to go to events in that area I started to meet people I started to like read books and write to the authors about it and kind of like make like little presentations and handouts and stuff and I met a lot of very interesting people.

In fact like I met astronauts I met with the, with astronauts who've gone to the ISS space station, I got to hold a rock that is from Mars.

JOANNE TEH: That's so cool.

SANGEETA AGARAWAL: Yeah and I got to meet with one of the chief medical officers who was at SpaceX and now at Nasa and I told them about all my crazy like ideas and they were like no this is great it's very real we need people who have this multidisiplinary background, because we don't have a lot of people who have that kind of background so I started to do educational lectures and educate other people about it, you know kind of drink the Kool-Aid on this topic and so being like at conferences and presented on it and doing like informal research in that area and I got- and UC actually has a UC space Health Community so I became a UC space Health fellow because I was like doing all these things and they're like yeah you're working on it.

So they made me a UC space Health fellow, then I've been doing like topics that are related to this area and I'm talking to TRISH which is the research arm of NASA and what else am I doing? Oh and then the space nursing society, they were like you are like so involved and so energetic on this topic do you want to like continue it and lead it and like okay so they handed it over to me. So I'm just, it's like a snowball you know that's gained momentum and I just hope I can continue to make a difference as the field evolves and as more people get into it.

I think right now there's more focus for like high school and school and you know that generation because they might be the generation that's actually you know traveling to other planets or to moon or Mars. So I do events, educational events for them and fun events for them, yeah.

JOANNE TEH: Mhm, wow this is really cool. Okay two things, one: I think at first like when I saw space nursing on your list of things that you like we could talk about I was like that's seemingly random but interesting but after you explain it as like a possible evolution of the field of Occupational Sciences, Occupational Health Sciences like that's like it's awesome I never thought about like how the field can evolve so like quickly that these almost fictional things can become a reality. Yeah that's a really interesting consideration about the field, and then second I think it's really awesome how you were able to take like some personal interest and then like snowball it to this level like wow. Like I'm personally a fan of science like science fiction but I would have never expected to be like ever in my life make it any part of my professional development but you said that you just like started attending events and like reading books, reaching out to authors, like that's how you entered the field?

SANGEETA AGARAWAL: Yeah, yeah and then I just started to like develop my own like documents and then I start- and people wanted me to talk about it so I went to talk to people and train them on what I knew so you know you just, you learn and then you contribute forward to people that want to learn from you and that's just how I feel like we can, we can grow and we can help other people to grow in the field.

JOANNE TEH: That's awesome I would have never thought to like just start attending like not knowing anything about the field prior I never thought to just attend or just like reach out to people, that's so incredible.

SANGEETA AGARAWAL: Online is a very powerful place and communities are very very powerful you just you never know. I mean honestly like it this is so random, so bizarre like I literally emailed the like you know people who are at the top level in the field of space Health called, messaged on LinkedIn. I was like this is what I'm doing, this is what I figured out so far, and you know this is what I've done ABC and now I'm doing XYZ. I have question about this thing or what do you think like is it too off, like how far are we in the field, is there anything real going on, you know?

And I was totally surprised you know that they actually responded to me here you know in the field, yeah so like Dr. Dorit Donoviel, she is the director of TRISH she's at I think Baylor College of Medicine in Texas. I messaged her and she was like so supportive and messaged me back and she was like yeah go for it and then I asked her questions about like topics even for my projects that would help me to go deeper into the field and I gave her some ideas and she was like yeah work on this particular thing, so I did that. And then actually in your podcast you had

Dr. Josh Potocko

I might be butchering his name. He's worked in the field of occupational medicine and Aeronautics. So I told my toxicology Professor about my interest in this topic and Dr Tamir and Dr Dennis Schusterman, they connected me to Josh and they're like yeah he can tell you like what you study and you know like what kind of projects you can do for your class that would be related to this topic so you can continue to you know do your class projects on topics that are related to your sci-fi interest. And I literally did that, I did research on, I did presentations and papers on beryllium because beryllium is an important part of part of Aeronautics.

JOANNE TEH: Oh my gosh that's so awesome. Wow, I have a lot to think about. I feel like usually people my age especially we'll kind of like shy away from doing that because it feels like we don't have like the balls to do that I guess you could say like it feels like we haven't really made any real contributions yet so like how could I dare to like reach out to this high ranking professional and like propose my little ideas, but like it works out.

SANGEETA AGARAWAL: I think the secret, the secret ammunition that we all have is the fact that we are a student. You're not reaching out just as anybody you're reaching out as a student and you're associated with the academic Institute that is known to be you know a leader in that area so that carries some weight, and reaching out from that perspective and saying hey I want to learn in a way it's a compliment because saying you know I think you are amazing and you are a leader in your area and that's why I'm reaching out to you and you can get some guidance. I think what's important is to keep the ask really really small so people are really busy, they are juggling a lot of things, so if the ask is something really small that they can you know respond to your message in two minutes and you would have got what you need, that's awesome now they've helped you, you got what you needed and it didn't end up being you know something that took up a lot of their time.

So I think keeping that in mind and secondly not taking it personally if somebody didn't respond just know you know they have a lot on their plate and that's fine, yeah. And just pay forward when you can in terms of supporting people and find communities that you can be part of where you do end up meeting people and you end up meeting people who will introduce you to other people you know who are passionate about your topic like, so UC is great with that and then like for Occupational Health there are a lot of great communities like for the nurses there is the El Camino Occupational Health Community that's in Silicon Valley that's really great and then there is OHP that's the occupational health professionals something that's a really great Community, UCSF, UC Berkeley is a great Community, the OEM conference is a great Community, there's the industrial hygiene meetings the AIHM I think they call themselves or something like that or AIHA, that's a great community so you just meet people through these different professional organizations and communities.

JOANNE TEH: Wow this is awesome, okay.

SANGEETA AGARAWAL: Find people.

JOANNE TEH: Yeah, this is a lesson to really take advantage of your network, okay, well in that case do you have any other things that you wanted to talk about that we haven't gotten to yet or anything you forgot to say earlier?

SANGEETA AGARAWAL: I mean I guess my question to you would be what do you think would help people who are listening, is there anything that we haven't covered that might benefit people?

JOANNE TEH: Well usually I ask questions like how would you help people like how would you recommend people to start networking or how would they start making their like professional or just like the professional development questions but I think you happen to answer a lot of the ones I had stored up as you were talking just naturally so I think it I think it'll be very helpful whether or not we have those specific questions.

SANGEETA AGARAWAL: Okay.

JOANNE TEH: Yeah.

SANGEETA AGARAWAL: Trying to think what else can help people. Yeah I think one thing I would say is failure is very real and it is a big part of life especially if you're going to go for aspirational goals and challenges and I would say I've faced failure couple of times in my life but one of the darkest times for me was when I had to wrap up my company because that was a huge what felt like a huge professional failure for me and what I wanted to do in terms of serving people, you know? I was actually making a difference, people needed what I was building and I had worked on it for years, people had worked with me on it for years, I feel like I, you know with any startup there is always a risk that things would fail there's 95%, 99% chance it would fail but I just somehow thought that I would make it work.

So I feel like I was letting so many people down, you know people who needed help like you know people are going through cancer and if I could have helped them and I couldn't anymore if I couldn't keep the company going so I feel like I was letting all those people down and you know and people who have been my mentors and advocates and who had passed on in fact so I just felt this huge lot of darkness and then people who worked on this with me, there were hundreds of people who worked on building this company and building this organization and supporting me through this and I just feel like I let all those people down so it was really heartbreaking to not be able to do what I could to empower you know people who were working with me and give them all the amazing opportunities or to be able to help people in the community which is what I set out to do or to be able to inspire you know nurses and other healthcare professionals because I got to a certain point and then it was like you know kind of falling off a cliff.

But at the same time it was pretty clear there wasn't a viable way to carry things forward with the way the contracts and things were, the operating cost of those contracts was in tens of thousands of dollars but the revenue for that wasn't coming in for what was committed from you know from those opportunities so it was a loss. So I did end up you know kind of kicking and screaming I did end up realizing I need to wrap it up and I did that but I went through this really I went through this really period of questioning myself and feeling like a complete failure and feeling like I can't show my face even in the community because who am I if I'm not this?

Where do I, you know everything that I had led up to my life was still the point of doing this and now if this didn't work work then now what? You know? Do I not care about my goal anymore, do I not believe in myself, is it even worth living, you know? I genuinely was questioning that because I feel like failure can be very real heartbreak and setbacks can be very very real and I feel like I was very fortunate that even in those times I kind of had lost even connection with my spiritual practices but I, but they still held me to just hold the space even while I was going through the darkness to say just be here you know, I don't know what it means but just be here and a path will come forward.

So I did days and weeks and months of just like wandering and doing nothing sort of but like meditations and silence meditations and silence courses to just say okay I'm nothing, I want nothing, I do nothing and it's okay to be nothing, I can still I have the right or I'm blessed to still be on this planet, yeah. And coming from that place of nothing and realizing that actually out of that nothingness is everything because as I embrace the fact that I'm nothing I started to say okay what can I do to give myself joy today? And I would just do little things to take care of myself because before that for six years I had not taken a break at all I had not you know like thought about myself and I started to do little things to take care of myself and then I started to ask people what do I do?

And as I reached out to people I thought they won't respond to me or they would hate me or they would say how could you let this fail or whatever but people were super nice and they were like yeah I don't know how you were even making it until now it was impossible but there are so many ways forward you know and different people shared with me their journey and their hardships and their struggles which I had not thought about before even though I knew entrepreneurship is hard or whatever, you know whoever is listening you're doing in your life there are people who have been through failures you know who've been through hardships so if you're going through that it's good to talk to them because then you see somebody else went through that, you're not alone, and you don't judge yourself as much and there is hope and a path forward.

So that helped to me because when I talk to other entrepreneurs I felt like they found a life after entrepreneurship, you know? and I talked to you know people who I had worked with or you know had different relationships and they showed me there is so many different opportunities and paths forward and different ways that I could continue and make a difference and I started to do that and I started to ask for help instead of being somebody who was the leader or who was the one who was helping people, I started to say I need help and that's how I ended up at UC because I said okay I'm passionate about all these areas and I need help. I want to find a community and I want to find a path forward and I feel like this might be it, but I don't know and actually Dr Lee who's in you know who's one of the key professors in the health program she talked to me and she said yeah, you know, you would be a great fit.

And you know we worked through a plan for it and other people you know, people at NCI, people in so many different areas help me to figure out okay there is a path forward so if you feel like one road closed or something was a major setback just know even if you can't see the path forward even if it's all black, even if it's all cloudy just have faith that you will find your way you will find a path forward and go and ask for help and connect with yourself in you know, with the depth of your soul and figure out what you have built so far in your life, what are the things you've done what have you accomplished so far in your life, because they will help you to realize how much you're capable of, how much you've already accomplished and what you could do and you reach out to people in the world and the world will help you just as much as you want to help people and make a difference and it becomes a more symbiotic relationship.

And that's what I love about my life today is I don't feel like I need to be somebody or you know I need to know all the answers I can just be who I am and say this is what I know today this is how I can help this is what I don't know and I need help and you know put a beacon out there and see if somebody helps me.

JOANNE TEH: Well those are actually, that's really incredible advice. I feel like this is a really hard lesson to learn especially like if you're if you haven't experienced a setback yet then like this is the type of information that you need to have under your belt so you can remind yourself when it's happening.

SANGEETA AGARAWAL: Yeah and it makes you a much more, all that experience even the hardships even the failure adds a dimension to who you are and to what you bring, you know whether it's to the community or to the work or your passion and that adds this richness and this diversity you know and like a fertilizer in the soil. So that makes makes what you do next so much richer like what I'm doing now in occ health and technology and different things is just so much richer because of my past experiences you know with what I've done.

JOANNE TEH: I really like that metaphor like fertilizer in the soil it's like the piece of manure that grows like a beautiful flower.

SANGEETA AGARAWAL: Yeah, yeah. It might feel like crap but then you know it actually ends up being the fertilizer.

JOANNE TEH: Yeah that's a good message well wow you have really dropped a lot of like advice bombs, knowledge bombs on me right now.

SANGEETA AGARAWAL: Thank you, I think everybody is amazing you know I really appreciate everyone who's, who took the time to listen and I hope, I know you've done amazing things in your life and you're going to do amazing things in your life and I hope that you found this time helpful and something that adds to your toolbox and I'm excited for you wherever you are and I hope you connect with me on social media and I can follow you as you follow me on my journey.

JOANNE TEH: Thank you actually for spending your time with us today.

SANGEETA AGARAWAL: Thank you so much Joanne, you're amazing with all the questions you asked and the way you facilitated this whole episode and I'm excited for you, for your career and what yuo will be doing.

JOANNE TEH: Thank you so much, thank you, thank you. I will definitely be following you on LinkedIn.

SANGEETA AGARAWAL: Thank you.

JOANNE TEH: Yeah, okay well that was an incredible conversation I'm glad you were able to join us today.

SANGEETA AGARAWAL: Thank you.

JOANNE TEH: Think that marks the end of our episode.