By Anne Makeever
Dineo Khabele, MD, FACOG, FACS, a specialist in gynecologic oncology, is head of the Department of Obstetrics and Gynecology at Washington University School of Medicine. She made history when she assumed that role in 2020, becoming the first Black department head at the medical school. She points out, however, that many such schools in the U.S. have yet to make a similar appointment. “I’m the first but don’t want to be the last,” she says, underscoring her personal and professional commitment to addressing racism and related health-care disparities as she fulfills her responsibilities as an academic leader, physician, researcher and community member.
Why did you pursue—and ultimately accept—your position as head of obstetrics and gynecology?
My role gives me the opportunity to train the next generation of obstetric and gynecology specialists, helping prepare them to provide compassionate, culturally sensitive, leading-edge care. Washington University School of Medicine is an important part of St. Louis, a city that— like other U.S. cities of its size and history—struggles with the problem of health-care disparities affecting marginalized communities: women, people of color and others with few resources. I accepted the position because there are a lot of talented and smart people at the university who want to work with the community to help solve this problem.
That mission aligns with my personal motivation: I want to make a difference. The job I have now makes it possible for me to help instigate change. I think we have a unique opportunity in St. Louis to lead the nation in developing new ways to address disparities in health care.
What caused you to choose medicine as your profession?
The same issues that motivated me to take this job caused me to pursue a career in medicine. Personal experiences I had when I was in medical school, living in New York City, made me even more determined. During that time, I saw vulnerable women lose the right to care for the babies they delivered because of substance use disorders. At the height of the AIDS crisis, I saw people dying alone in hospital rooms. How do we confront serious problems like these? How do we—as physicians, as a community—do better?
Now we’ve lived through a pandemic and again have seen people dying, isolated from their loved ones, facing a medical crisis without a support system. What can physicians and hospitals do to address problems like these? How do we improve care for everybody? Those are the questions I’ve asked throughout my training and career.
And they’re the same questions my colleagues at Washington University Medical School and Barnes-Jewish Hospital are asking. This is a special place, an environment that attracts people who are curious and compassionate, who want to change things for the better. Working together, we want to move science forward rather than accept things the way they are.
Why did you choose to focus your career on women’s health?
I specialize in the field of gynecologic cancer because we need better treatment options for women. And we need to figure out how to prevent this kind of cancer in the first place.
That taps into an argument I make wherever I go. If we do a good job caring for the woman who comes to the hospital to deliver her baby, who looks to us for contraceptive care and preventive medicine, then we are also helping that woman’s family—her children, her partner and parents. Women often are the keepers of their family’s health; when they’re healthy it makes a difference to those in their lives and to their communities as a whole.
How does your desire to address health-care disparities affect your role as a gynecologic oncologist?
The incidence of endometrial cancer is rising in the U.S., and that increase is particularly alarming in marginalized populations. Black women, for example, are two to three times more likely to die from endometrial cancer than white women. I think there are many reasons for that.
One reason is that women and the physicians who care for them too often normalize abnormal symptoms. For example: Black women are prone to having uterine fibroids, which often are harmless but come with symptoms—some pain and bleeding—that are similar to those for more dangerous tumors. But because they are common, fibroid symptoms may be ignored. As a result, many Black women are diagnosed with gynecologic cancer at a stage of the disease that is more dangerous to their health.
Another reason is that Black women tend to take care of everyone in their lives—except themselves. They’re conditioned to make sacrifices, which sacrifices their health.
How are you and your colleagues working to address cultural and community-based issues like these?
Our department’s Division of Clinical Research issues pilot grants to support selected projects. We work with a community advisory board to help us determine which research projects to fund. The members on the board tell us what they think is most important to their community. Structuring the granting process this way emphasizes community need.
We also partner with the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, and other groups on the Medical Campus, to help reach Black women in the community through their churches. In one instance, we invited women who are leaders in their church to a wellness event and asked them to invite church members. At the event, we offered mammograms, vaccinations, blood pressure and glucose checks, and information about health and diet. Again, we let the community lead; we went to them instead of asking them to come to us.
Our faculty and staff also work with several community-based organizations committed to preventing cancer: Pedal the Cause, the St. Louis Ovarian Cancer Alliance and the Pink Ribbon Girls, to name a few.
How is treatment changing for gynecologic cancer?
The good news is that women diagnosed with ovarian cancer are living longer than ever before. In some cases, women with stage 3 or stage 4 ovarian cancer can be treated successfully. Still, too many succumb to the disease.
Part of the reason is that cancer isn’t a single disease; it includes multiple subtypes. To improve treatment, researchers are working to better understand the biology of these subtypes. For example: We used to think endometrial cancer was less dangerous than ovarian cancer, but there are subtypes of endometrial cancer that look more like ovarian cancer and don’t respond well to chemotherapy. And if these tumors do respond, they may return and be more threatening. Scientists are working to understand the molecular features of these subtypes so that more effective and targeted treatments can be devised.
What are you working on in your lab?
I’m looking for the answer to a question I’ve been asking for a while now: Why do some ovarian cancers that look similar under the microscope behave in dissimilar ways? About 80% of ovarian cancers are sensitive to initial chemotherapy, but 20% aren’t. Why is that? The answer can help medicine design better treatments.
How does your interest in health-care disparities affect your work in the lab?
One of the reasons I’m looking at treatment-resistant cancer subtypes is that they often are seen in people who are marginalized. Are environmental factors causing that difference? Is there a social determinant involved? Those are important questions.
It’s vital that we have people who look like me working to identify and answer questions like these. The number of Black researchers funded by the National Institutes of Health (NIH) is too low. We need more women physician-scientists, who care for patients and do research in the lab; their work will help develop new diagnostics and therapeutics. We need racial and ethnic diversity in the medical profession to help ensure health care is accessible for all.
I’d like to draw attention to another health-care disparity: health and wellness within the medical profession. The SARS-CoV-2 pandemic uncovered a significant problem: Doctors, nurses and other clinicians too often don’t take good care of themselves. Our department is made up of men and women who are passionate about caring for others. We have a national reputation as a leader in obstetric and gynecologic medicine, and in research. We make important contributions. I want to be in this profession for the long haul, and I want that for my colleagues, too.
I believe one of my roles as head of the department is to help my colleagues recognize the importance of their own health. It’s just like the Black women I talked about earlier: We can do even more for the people who need us and the communities we live in when we take care of ourselves.