Article 3: Nabila El-Bassel

Fathomless problems transfix curious minds. Whether the problem is a matter of public policy, racial justice, or scientific inquiry, the investigator stands up to it in submission and defiance, humbled by its complexity and committed against all odds to see it to its conclusion.

A narrative medicine interview by Rita Charon

Narratives of Discovery

 All non-referenced quotes are the words of Dr. El-Bassel

Nabila El-Bassel—University Professor and the Willma and Albert Musher Professor of Social Work at the Columbia School of Social Work—has answered the call to investigate seemingly insoluble social issues of inequities in health care. She has committed her career to probing fraught socio-clinical problems that afflict poor communities of color: HIV transmission, the global opioid crisis, mass incarceration, gender-based violence, violence against sexual minorities, and the refugee crisis. I asked her what accounts for her unflinching investment in the well-being of those most challenged by poverty, racism and homophobia; those most violated and whose voices are suppressed. She answers by telling me about writing a paper in high school—she a Palestinian in a private school in the city of Yafa—about the 14th century Arabic historian and jurist Ibn Khaldûn, author of The Muqaddimah: An Introduction to History and Sociology:

"I wrote an essay about him and I continue embracing his vision. He's the founder of sociology. He believed in human agency, and he believed in social networks, and how to address social issues by using science and observations and data-gathering from the communities. He says that you always need to understand the macro-community approach and social conditions of people and bring science and culture into it. He said that in order to solve social issues, you need to bring the voices of the people into this solution. I took his words very seriously."

 [History] is information about human social organization, which is itself identical with world organization. It deals with such conditions affecting the nature of civilization as . . . savagery and sociability, group feelings, and the different ways by which one group of human beings achieves superiority over another.” [35][i]

              Young Nabila was riveted by the altitude of Khaldûn’s vision. She has never forsaken the privilege to see from a meta-level beyond nations and states, beyond race and class, beyond time. She studied at Tel Aviv University, then Hebrew University, and then was drawn to Columbia’s School of Social Work for a PhD that incorporated research in social work with graduate courses in sociology and public health. Besting Khaldûn, Nabila embraces a galactic-level view of planet Earth while dealing individually with persons fatally entangled in such concrete realities as capitalist economics, global drug trafficking, U.S. neoliberalism, misogynist gender roles, and mounting deaths by despair.

              In 2019, Nabila and her colleagues were awarded $86M from NIH’s HEAL (Helping to End Addiction Long-term) Initiative to test their community-based interventions designed to reduce opioid overdose deaths. This was the first time that NIH had awarded such significant research funding to develop and evaluate a community-engaged intervention to solve health and social issues and to treat opioid addictions.

"The model is to create a coalition within each county that consists of people with lived experience with drugs or family members who have lost people because of drugs and also policy makers, health care professionals, scientists, local government officials, clergy, communication and media experts, and more to come up with best strategies to be implemented to solve the issues. And to study the process, to study the process."

Principal Investigator El-Bassel is uniquely qualified to lead this research. She brings robust expertise in conventional public health epidemiology fortified by daring study intervention designs, community engagement, and a variety of approaches including implementation science, data science, machine learning, systems science, and social media analysis. Her training in social work laid the foundation for her community-driven approach and equips her with the aesthetic capacities to closely observe and interpret the appearances, ethical contexts, and subjective plights of those she studies. She can then reciprocate with intersubjective attunement to the individuals, including persons affected by substance use, women engaged in sex work, persons in the criminal justice system, and those who experience gender-based violence.

The Social Intervention Group (SIG) at Columbia School of Social Work is Nabila’s nerve center. SIG develops and implements evidence-based sustainable solutions to socioeconomic health problems affecting under-resourced populations worldwide. Established by Robert Schilling and Nabila in 1990 to study HIV, SIG expanded under Nabila’s leadership to provide novel HIV prevention and treatment protocols, community-based and harm-reduction approaches to substance use, and approaches to gender-based violence, mass incarceration, and global health care for war refugees. Solutions move, in Nabila’s words, “from discovery to implementation science, discovering what kind of interventions the community needs. Are the interventions available or do we need to build the interventions to move into efficacy trials and then to implementation?” The CDC has identified many of SIG’s interventions as best practices, and SIG’s work has spread globally with the establishment of the Global Health Research Center of Central Asia (GHRCCA) in Kazakhstan, co-directed by Nabila and her SIG colleague Louisa Gilbert and jointly supported by NIH and local Central Asian government agencies.

I first met Nabila at a pre-COVID-19 SIG project meeting on health care for Syrian refugee women in Jordan. There, I witnessed project members providing feminist, gynecological, infectious disease, historical, economic, diplomatic, and religious perspectives to consider, each contributor clearly impassioned and informed. Nabila sat at the corner of the conference table, highly attentive but not directing the action. She had purposefully recruited and mentored each of these young scholars. She is able—and it hadn’t occurred to her that she had this gift until I mentioned it—to recognize the hidden strengths of others. She sees into, as it were, their depths:

"We know that each one has a voice that is important to hear, to come up with a collective vision. Pre-docs and post-docs don't want to leave because they believe the vision and the teamwork is really giving opportunities for each person to flourish and do their best work. We need the expertise of each of us."

Honored as this year’s recipient of Columbia University’s “Mentor of the Year Award,” Nabila oversees an NIH-funded R25 training program on mentorship for underrepresented faculty researchers studying HIV, called the HIV Intervention Science Training Program (HISTP).

She also directs a T32 training program for social scientists in the areas of criminal justice, HIV, and gender-based violence.

Nabila recognizes the hidden strengths not only of her mentees but also of her research partners/subjects. This gift of recognition is the engine of successful social intervention projects, whereby the ethos of a personal investment in the future of the individual client is transmitted throughout SIG. She told me about an intervention study she and colleagues implemented to enable women in jail to maintain social networks, interrupted by incarceration, so as to have a community to return to upon release. “Many of the women, she says, “were isolated from their social networks prior to incarceration. No one wants to talk to them.” She tells me about one woman in her study who was able, with Nabila’s coaching, to resume contact with a relative who had rejected her because of her drug use and incarceration. Upon release from jail, this woman became engaged in work and was able to live with this supportive relative from her past, thereby reducing her likelihood of recidivism and improving her chances for lasting change.

To prove that these are not “n-of-one” successes, the studies that Nabila conducts require multi-disciplinary scientific methods including complex data science, social media analysis, and in some cases spatial autocorrelation analyses that allow them to study on-the-ground aspects of opioid use.[ii] Her team’s implementation science approaches take stock of the community’s present resources and assess barriers to and promoters of the implementation of the intervention, integrating the voices of the community in all the stages of study implementation. She has turned to systems science in her determination to incorporate community engagement into her HEALing Communities study:

Systems science includes quantitative and qualitative modeling and analytical approaches that focus on understanding the behavior of complex systems by studying system components and their dynamic interactions at multiple levels. . . . [It is] a powerful tool for community engagement and advances equity by incorporating voices from all stakeholders (including those frequently marginalized) and permitting identification of the community-specific drivers of inequities through the use of local data.[iii]

              Using multiple systems science tools, Nabila’s teams equalize power hierarchies across researcher and community by identifying what matters most to the persons suffering the impact of the problems under study. Her HEALing Community Study provides evidence for the efficacy of the hard-won leveling of power—not easy for either scientist or community member—and the resultant exposure of hidden gears within the machinery that lead to unnecessarily early deaths.

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History makes us acquainted with the conditions of past nations as they are reflected in their national character. . . The past resembles the future more than one drop of water another. [12]1

Khaldûn taught Nabila to consult with the past in order to dream the future. How do slave trade events starting in 1619 determine the racial profile of the U.S. drug crisis today? How do the 19th century industrialist robber barons continue to choose today’s winners and losers? When did masculine gender roles arise that today imperil the safety and survival of women?

Perhaps the hidden gifts of this extraordinary scientist, social worker, mentor, and visionary include a near-mystical capacity to see into the future. As she unleashes the power of frontier methods from digital and systems science arsenals and as she refuses to back down from what others consider insoluble social issues, she foresees a future of justice and safety for even the most marginalized groups today. Her vision of this future is her lodestone toward ever-more-capacious conceptions of “human social organization, world organization, the nature of civilization, sociability, group feelings, and the different ways by which one group of human beings achieves superiority over another.” Armed with her faith in human survival, Nabila El-Bassel raises our lowered gaze toward the possibilities—she would say certainties—of a future of fairness, justice, kindness, and care.