The Health Management Academy

Episode 15

Assessing the Health Policy and Investment Landscape

Featuring Adaeze Enekwechi, Ph.D.

Episode Description

In this episode, Adaeze Enekwechi, Operating Partner at Welsh, Carson, Anderson, & Stowe, joins Renee at The Table. The conversation covers Adazeze’s wide array of experiences including growing up in Nigeria and seeing firsthand the role of government and the value of public service. Other topics include current issues in health policy, emerging investment opportunities, the role and function of healthcare and non-profit boards, and more.

About Our Guest

Adaeze Enekwechi, Ph.D., Operating Partner, WCAS

Dr. Enekwechi is an Operating Partner on the Healthcare team, having joined WCAS in 2021. Dr. Enekwechi focuses on a policy and regulatory environment that can have an outsize impact on healthcare investments. Dr. Enekwechi is trained in healthcare economics and outcomes research, and led IMPAQ, LLC, a company that provided research, technical assistance, and advanced analytics services for government clients which she took through its acquisition in 2020. Read more…


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Renee DeSilva 00:07
Welcome back to the academy table. I’m Renee DeSilva, CEO of The Academy and your host. In this episode, I had the pleasure of speaking with my friend and colleague Adaeze Enekwechi. Adaeze is an operating partner at private equity firm Welsh, Carson, Anderson, & Stowe and has led numerous healthcare organizations in the public and private sectors. Here are a few of my takeaways from our conversation. I often asked my guests about the early forces that shape their career, and I loved hearing Adaeze’s reflections on this question. She spent a number of her formative years in Nigeria before her family emigrated back to the United States. And so even at a very young age, she had clarity on the function of government and the value of public service. What happens when governments don’t fulfill its obligation, and it’s incredibly clear how that still influences her work and viewpoints today. Next, Adaeze offered up a masterclass on health policy. So get your pen and paper out and take a listen. And we talk about current issues, lame duck priorities, potential areas for bipartisan agreement, and there was at least one in there, improved health system government relations advocacy. It was a treat to have her walk through all of it. And finally, we covered her extensive board service with health systems, not for profits and venture backed companies. The way she approaches her board work is useful advice for all the additive, be comfortable in your skin and come complete. With that, let’s head to the table.
Adaeze, welcome to the table. So happy to have you join me today.

Adaeze Enekwechi 01:50
Thank you, thanks so much.

Renee DeSilva 01:52
I want to start with your background, you have a unique blend of public and private roles, and you have a foundation as a healthcare economist. So just start by telling us a little bit more about your career path.

Adaeze Enekwechi 02:05
Well, I always describe it as the scenic route. You know, I started off in public policy, like pure public policy, public finance. After undergrad I, you know, I knew what I wanted to do. I was always attracted to the public sector, really around this issue of how do we make decisions around the allocation of resources for various functions that the government is responsible for? I knew that in like eighth grade.

Renee DeSilva 02:37
How did you do that in eighth grade?

Adaeze Enekwechi 02:38
I knew that it solidified I guess, based on what I’ve read, you know, I was always a pretty avid reader. By ninth grade, I was sitting in a class and it was like, you know, civics was basically civics in American Studies, a little bit of history. And just, you know, the notion of a functioning government that works, the three branches, the complexities, you know, was always very interesting to me remember, as well, you may not know this about me, when I when I was a very young child, I spent my formative years in Nigeria. So I lived and which is, you know, the majority of the 1980s was led by various dictators. You know, I knew what government was, and it wasn’t a good thing. It was, as you know, a number of coos, that led to people being killed if they were unsuccessful. transitions of power are generally quite violent. I remember the one cause. This is an interesting fact, when I was a child, a kid in Iowa City growing up later, the tornado drill. So how you are supposed to protect yourself, if there’s an active tornado is exact same as the drill for if, you know, if during an insurrection, gunfire erupts, and you are in class or in school, like it’s exact same thing, how you get next to the wall, get away from the wall, get away from any broken glass and windows that could hurt you, under your desk, cover your head with the exact same thing. So as a child in Nigeria, living in what was pretty extreme, like almost, you know, an oasis at the University of Nigeria, which is a college town. My parents were academics. You know, this idyllic, beautiful town I had, it was basically a cocoon for 889 years. But the government around us, what was called a government was it was dysfunctional. And for a child, for me anyway, maybe I was just one of those kids who felt everything it felt dysfunctional. So move on to you know, early, you know, 1211 12 and early teens in high school was like, Oh, wow, this is Fanta aspect I think I was always just, you know, more oriented towards civics, government economics, that was always much more interesting, which is not something I could explain to my parents. Really well, you know, we’re Nigerians my parents are. Academics is supposed to be majors. I always tell this joke: you have four options, a lawyer, a doctor, an engineer, or an embarrassment.

Renee DeSilva 05:28
You created a fifth for yourself.

Adaeze Enekwechi 05:31
I got a PhD, which you know, which was, which is perfectly acceptable. But this is a household where when I graduated high school, I noticed that all my friends, their parents were having parties for them, celebrations, all sorts of stuff. And I was like, Mom, am I gonna get a party? She’s like, for what? Right? High school graduation is? Yeah, just like, This is not an achievement in any way. You suppose when you finish your masters or PhD, then we can talk?

Renee DeSilva 05:59
Sorry, I love that. I love that. You know, and this is true for all of us, how just the different experiences that are peppered through our early childhood sort of impact how we see the world for you that came into aperture much sharper than I think it does for most folks at an early age. What’s your sort of just broad brush take on the healthcare policy arena as it sits today?

Adaeze Enekwechi 06:23
We need an omnibus for fiscal year 2023. Yeah, I My sense is, that will likely happen. There’s this Congress, this lame duck session has a lot on its plate. But that’s like, that’s number one that has to be done. I think for some of our hospitals, system listeners, you know, the Pagle sequester, I’m sure is top of mind for all of their government relations people. You know, when I left the government,

Renee DeSilva 06:51
I’m sorry about that. Just explain that for people when that is familiar.

Adaeze Enekwechi 06:54
Yeah. So you know, the people’s sequester is from like, it’s an act from 2010, which basically says that Medicare payments will be cut by 4%. You know, every year and right now, it’s late, it’s a start and it’s delayed every year. And right now, that delay expires under this car, and will, you know, in theory, start on January 1 2023. Pay go has never been implemented, those cuts have never been implemented, I never fully appreciated the energy that is spent among hospital systems, right? Nonprofit, large nonprofit hospital systems, consultants, lawyers, I never appreciate how much time and energy is spent on this with, you know, modeling what this will mean to but you can imagine a Medicare cut of 4%, how impactful that could that would be on any hospitals and hospital systems budget. But it’s you know, there’s no appetite, it’s a, it’s this budgetary gimmick, I don’t want to call it a gimmick, because it could one day, it could be real, but it’s highly unlikely it won’t happen this time. And yet, every year, the Congress basically waits until an extenders bill at the very end of the year, or an omnibus package that is negotiated, you know, at one o’clock in the morning and voted on, to then make this reality and everybody can then rest the next year would do the same thing. So that’s a long way of saying it’s the law. It’s in the books as something that will be triggered come January next year, highly unlikely, and the Congress will have to act on it. They have nothing to gain by doing this. And I think, yeah, that was just gonna mention mental health, just a couple of the things that I’ve heard are sort of percolating. There’s great interest just given what we’ve gone through from the pandemic, but this predates the pandemic. You know, mental health crisis. Now is a series of crises, quite frankly, there are various elements to the mental health crisis. I know that there’s some Bill texts floating around, you know, I think House Ways means had a hearing a lot of interest in doing something in the space, whether that will culminate in a single singular piece of legislation during this lame duck session, I think is unlikely, just given how challenging you know, these types of bills are, but there’s bicameral and bipartisan support to pay closer attention to fund, you know, different types of mental health providers. It tends to be a focus and outsize focus on the doctorally trained mental health providers, whether it’s PhDs or MDs, but given the scope of the problem, or the gap, if you will, and the unmet need. There’s a greater call to focus on community health workers are the types of licenses that are below the doctoral level so that we can at least begin to put a dent to this greater call to diversify the pool of mental health providers because we see increasing unmet need in various Latino, African American Native American populations. And so just to pay better and closer attention to that, to think about training very differently, think about the workforce, even workforce sorry to jump around, but the workforce issue and the scope of the scale of that problem within health systems. While it is, I think it is finally resonating among staffers on the hill, again, what to do about that is less clear, whether that will be acted upon in the lame duck session, what to even act on, I think, is also less clear. And so, you know, I’m managing expectations on some of these nice to haves, we would certainly like to see action. But to the extent it’s undefined as to what the right action is, or to the extent that it’s quite complex, just given the scope and the size of the problem, and that you have multiple committees, bicameral committees working on it, so it will take time to come up with a unified policy, even if it’s broad in scope, I would just manage my expectations around that during the lame duck session.

Renee DeSilva 11:13
I think that’s right. Although I want to press on one thing that you mentioned. So we sort of all know that. The country’s healthcare is not unique to this has become increasingly polarized and can be hard to get consensus around any one issue. Are you optimistic in any of the things that you just said? Are you optimistic on maybe a mental health and example being a through line that could cut through some of that separation? A bit just given?

Adaeze Enekwechi 11:37
Yeah, I’d think Yeah. I’m more optimistic on telehealth. To be honest, because I feel like there’s I don’t feel what we’ve heard from lots of people. What we’ve heard from, you know, both folks in the public sector and certainly in on the provider side, is that, you know, public health emergency that was instituted, as you know, in response to the COVID pandemic, by this administration, the Biden administration introduced flexibilities around telehealth, which have turned out to be for many people, quite transformative. Even in something like mental health, right, being able to access a mental health provider from your home, being able to get a lot of you know, a lot of healthcare done through telehealth means has been quite transformative, to go back on those provisions. Because they are set to they weren’t initially set to All expire at the end, once the public health emergency sunsets. But as of March this year, the Consolidated Appropriations Act of 2022 extended some of those provisions by 151 days after the end of the public health emergency. So we don’t have a date. We don’t even have a signal yet. I’ve been sort of looking around to see when this is the current PHE. Like will, whether it will be extended after it expires in January. But some of these provisions will stay on for not all of them, some of them for 151 days after the expiration of the PhD. My sense is that there’s an appetite to make them certainly, certainly at the minimum x, extend those beyond the 151 days and extend others that you know, I’m sure others are better equipped to sort of rattle off the top of their head. But like the originating site, one is a good example to be able to get paid for accessing services from your home, to have the provider be paid or be reimbursed when they treat a person from their home. And that’s the originating site. Now, that is an example of something that’s meaningful, pretty foundational. It’s pretty foundational right now. And I think there’s a push to nudge policymakers that have been reticent but reticent for the right reasons, I have to say, because we have program integrity, excessive use, if you will, you know, just you know, program integrity concerns where people can basically start charging for services delivered or not delivered and will be very difficult to verify because again, telemedicine is sort of new to the Medicare construct. So, you know, working our way through that pretty quickly in the next year or so I think would be one place where we would see great interest on a bipartisan level. This isn’t long, where Congress can work together.

Renee DeSilva 14:42
Now for sure. Let me ask you one other question before we transition outside of policy, which is, you know, from the lens of how to break through the noise. What advice would you give to stakeholders that need to build effective messages and communications to policy folks. In light of what you mentioned, lots of things are moving quickly. Lots of new staffers, not all of whom necessarily are deep on every single health care issue. If you are a health system, or even folks who are working within healthcare, is there some advice? And how do they actually put a position or their opinion forward in a way that breaks through the noise and can land?

Adaeze Enekwechi 15:25
So I think my advice is usually this: think of the policy apparatus as a very heterogeneous entity. If you’re going to Capitol Hill, and you’re talking to 25 year old staffers who have very limited experience, period, let alone experience in healthcare, breaking down in very digestible form, what the goal, what the pain point is, right? How does this affect how this policy or this gap and policy affect health systems and making the direct link? So what could we use? What would we like to see Congress act on in order to alleviate this issue is key: it is a different conversation, it is digestible form. It’s also coming and saying, oh, it’s not just me in one hospital system. But there are 50 of us that are going through this challenge. Here, the consequences, it affects patient care, it affects x as it affects our ability to do our job for the constituents that you serve. Right. I think that conversation is key. I think people should talk to OMB, there’s always a lot of reticence around speaking to folks at OMB, but they do listen. But I also think coming in and communicating having been ready to have an intelligent conversation about incentives, because they want to understand that their job is to be proper stewards of the Medicare trust fund, understanding what their mission is, and what they are tasked with doing, I think, I think helps stakeholders better make their case because at least you understand the motivations of the group sitting across from you. So you’re less likely to come with something that they absolutely cannot hear or do was to me a wasted meeting. I knew when I was a regulator on that side, I knew within five minutes, which meeting was worth my time when I was listening to stakeholders, if they came in telling me to do something that was just asinine and just absolutely countered to my job as someone who was, you know, in the government, the meeting was in my head, the meeting was over, even if I stay for 30 minutes.

Renee DeSilva 17:42
Yeah, right. Like figuring out the right way to communicate the message in a way that lands is incredibly important. Yes. All right. Let’s change gears a bit and talk a little bit more about your more recent role. So last, you joined Welsh, Carson Anderson Stowe, which is a private equity firm in New York. Talk a little bit around how you think about your academic and policy and private sector background, coalescing? Why did you make that choice in terms of your next career step?

Adaeze Enekwechi 18:12
Yeah. You know, when Welsh called me, I was quite surprised. I had to, you know, Ryan called, and I asked him for questions to make sure to confirm he was calling the right person, you know, and I was like, Are you sure? Like, this is why I am? Are you sure? He’s like? Yes, yes. Because I honestly had never thought about private equity, I’d certainly never thought about investment than I ever thought about private equity. At all, I was ready, I had just run a fairly sizable company that I took through m&a. So it was acquired by strategic and lead integration for six months into the strategic and then I took my exit, and I took my leave. So my next natural role I thought was to be a CEO, again, of something else, perhaps staying in the consulting firm, or being CEO of something, just you know, whatever. So that was what I was thinking about doing. Well, I just called and made this case that I had never considered, which is the fact that you’ve got an academic background. So you understand research, you understand science, coupled with the fact that you’ve worked in the highest levels of government, so you understand the regulatory infrastructure that healthcare companies have to operate it. And you’ve been part of that. Added to that the fact that you’re an operator, you’ve run a couple of things, including a 100 million plus company actually makes you an ideal and ideal partner and an investment firm. I didn’t see it honestly. And he says, you know, the idea was, you come with a unique set of skills and vantage points that help you see See the landscape in a way that is very different from someone who grew up professionally. in investment banking, it’s one thing to to read, to talk to analysts, it’s another thing entirely, to have been in a number of seats in the federal in the government to have been in a seat where you’re the one who owns p&l, and have those quarterly, you know, pressures, if you will. And HR. I mean, just when I think about some of the stuff I had to do as the president of impact, it was, you know, it’s very different it, you know, and having that appreciation gives you a unique set of appreciations, I guess, a unique set of it gives you an appreciation for some of the unique challenges that the CEOs of portfolio companies may have.

Renee DeSilva 20:46
Absolutely, that’s a true ground for the practical reality, and then to just identify or assess investment opportunities, both, you know, the way that they might play out from a thesis perspective. And then there’s also the practical reality of when you add people and complexity and all of that to it. Yeah, I think healthcare,

Adaeze Enekwechi 21:04
you know, Renee, you know, this healthcare is the most regulated industry domestically, having a sense of what companies have to face what investors have to contend with as they think about investment decisions, whether to go in a direction or not go or if you go, what the headwinds might be what the tailwind might be. And again, there’s no crystal ball. There’s no clairvoyance here. It’s just that when you there’s a certain kind of muscle that you build after 20 years, on this other side, that comes into play, that can help bring an invent some different level of focus to an investment thesis. I don’t want to be Debbie Downer all the time, by the way, because you know, positive people can always see downsides, Mark. Yes. Why? Yes, I am so good at spotting why something is problematic. So I try to stop myself and say, Wait a minute. Okay, this is a headwind. How could we add to the story? How could we add to this ecosystem? And increasingly, how do we better communicate what we are bringing to this company, to the sub sector, to the industry, because we haven’t been good about that.

Renee DeSilva 22:19
And private equity, which is, I think, explains why, you know, the narrative around PE has been pretty abysmal the last few years, and sustaining on that saying on this investing theme for a second, when you with that lens, in terms of seeing where there’s opportunity, and finding new ways to create value within better company concepts. Are there a few major themes that you think we should be paying more attention to?

Adaeze Enekwechi 22:39
Yeah, I mean, there’s, there are many things that, you know, when I think about one thing that I’ve been focused on is workforce. And I’ve talked about this in a number of places, I don’t see public, I don’t see quick public solutions to the very real and very pressing workforce challenges health systems are facing not just health systems, by the way, most actors and most providers on the healthcare side are facing major, major gaps, if you will, that, you know, when I think about some of the solutions that are on the market, they go from standard, you know, locum nurse providers, you know, contract nurses, to much more nascent, much newer tech, focus tech, everything is tech enabled. And sometimes when you dig in is like, what is the differentiator tech enablement here? So this is huge gamut. That’s all focused around, ostensibly around solving the workforce crisis. My hope, my expectation is that will be refined over the next couple of years. It’s been surprising to me how little how few companies out there truly doing anything meaningful, but that perhaps that is perhaps why we find ourselves with the supply gap with the distribution gaps that we know, that we see across the country between urban and rural. And I think a solution that ramps up the training of nurses, you know, engagement once they are hired into healthcare systems, adequate pay more equitable pay structures, between contract and full time, and hopefully, over time, less of a need to rely on very expensive contract nurses that are simply unsustainable for health systems. That to me is a key challenge. Honestly, if a hospital or hospital system has to close beds because there’s no professional there’s nobody to staff that bed. That is not that cannot an optimal solution. Nor do I see a solution where the federal government will come to the rescue and there’ll be some turnkey, you know, fix. I just don’t see that how

Renee DeSilva 25:00
So Is that happening either. And so you and I, we spent a lot of our time with health systems. I’m on the board of a nova, you’re on the board of Unity Point and MedStar, which is also in our neck of the woods. So maybe let’s just maybe turn a little bit to board work. And I mean, you mentioned the workforce. And that’s a topic that I think about so let me say it this way. Think health systems have never felt more financial pressure, it probably feels like the 1997 Balanced Budget Act, level proportions. And I think a lot of that is driven by the increasing inflationary environment, the workforce demand, certainly some of the maybe headwinds as it relates to investment performance. And so it’s just a challenging time to be in a provider in a provider slot. So I guess, commenting a bit on that, when you’re chatting with your fellow board members, what are the other issues that are coming up from a governance perspective as it relates to not for profit health system boards? And maybe I have not yet mentioned it?

Adaeze Enekwechi 25:57
Oh, so yeah, this is probably the number one balance sheet. I, you know, I think you were actually quite charitable hospital systems are facing the worst balance sheets that any CEO has ever seen in their careers, like, you know, we have seen this kind of this combination of high labor costs, high inflation, high input costs, a reimbursement environment, that’s not going to turn on a dime, right? You’re not going to have commercial payers and public payers all of a sudden, you know, ramp up and start paying in a way that’s commensurate with the cost of inputs. So it’s very, and that’s across the country. Yeah. I think that’s number one. Every CEO, not just health systems, I think any CEO, especially in healthcare, is right now tasked with managing the heck out of your business, anywhere, where there might be waste, or opportunity to be more efficient, investing in that. And that sometimes could mean hard decisions, like tough decisions. But that could also mean when I say tough decisions, I mean, that could mean like streamlining, whether it’s people or resources. But it could also mean increasing your investment in particular areas, if there’s an area and technology, because cyber is always on the table as well. So let’s just use that as an example. If you need to beef up your cyber security apparatus, just given the onslaught that we’ve seen from nefarious actors, this is probably not the time to slow down, right, this is probably the time to invest in that because that does, you know, gaps there, or weaknesses in that department could mean even more adverse outcomes to the business. So I think this time presents an opportunity to build the business in the places that matter the most.

Renee DeSilva 28:05
Yeah. And let me ask you one other question there. So now channeling, you’re also on a for profit board. So is there anything from your for profit board experience, that you feel like that segment gets right, that not for profits need to take a page from that book?

Adaeze Enekwechi 28:20
Oh, gosh, that’s a tough question. Mostly because I don’t think that I think, you know, Renee, you’re gonna pull this out of me, I don’t make huge distinctions between management of a non of some of these large nonprofit companies from management have a for profit. To me, it’s a tax designation, management is management, tough decisions. Face both operators, both CEOs, and, you know, both management teams, nobody has unlimited anything. And therefore, you have to, you know, that there are resource constraints that simply have to be dealt with. I see the for profits doing the same thing as the not for profits. So on the for profit side, maybe you wanted a chief marketing officer or a chief, whatever. And you’re gonna have to put that in the back burner right now. Because you actually need to focus on revenue cycle, you need to focus on, you know, perhaps the more sort of operational nuts and bolts issues in the company. The not for profits are doing, you know, they’re doing the same thing. So the tax designation, honestly doesn’t feature. I mean, one reports EBIT the other one reports EBITda without the T one reports.

Renee DeSilva 29:41
Yeah, I think I agree with you. I think I agree with you. Maybe the only thing that I might say is sometimes I note in for profit environments, that there is a bit more of ruthless prioritization, perhaps because you don’t have all the regulatory forces often or you maybe are not as friendly and had to mission. The one thing that I may know, in, at least not for profit providers is sometimes there are things that you’d love to not have to do. But there was a mission, or there’s a community need. And I think that sometimes it maybe makes the lovers a little bit harder to work with. But I think I do like your distinction, I think. I think I mostly agree with you.

Adaeze Enekwechi 30:19
Yeah. Yeah. The mission part is interesting, at least the board that the for profit board that I’m on, it’s actually clear. It’s venture capital backed. It’s a women’s health company. I’m not on a forum. That is my next career goal to join. You know, public board, yeah, publicly traded board. But the VC bet there is a TIA I guess I can mention. Tia is unbelievably mission focused. This is a women’s health company. And that Northstar is never far from any discussion. I don’t care what we’re talking about. That is the guiding star, the guiding principle, how do we serve women and as as widely as we can define that, and the expansively as we can accommodate that I’m talking about the different payers, right, commercial, Medicare, Medicaid, and at some point, Medicare, that, you know, it’s a newer company, but even though it’s for profit, and venture backed, and we have an all women board, by the way, right? Yeah, we do. I know. It wasn’t planned, but here we are. It is a fantastic company where I think they may not use the word mission, like you might see or community like you might see at a MedStar or ANOVA, or UnityPoint, any point, it’s all about community just you know, it’s a Midwestern is a culture, there have being very close to the community. But Tia as a, you know, venture backed for profit company is not is never unclear about what their goals are and what they want to offer to the marketplace. So

Renee DeSilva 32:00
yeah, yeah, I think that’s right. I’ve gotten to know both Wenchao O’Keefe and Carolyn Woody, who’s the CEO. And I think, yeah, exceptional. Maybe one other just questions that. And we’re gonna wrap up here quickly. But so through the lens, the intersectionality lens of a woman of color, how does that come through and board situations for you, I mean, we all know that there’s been a very broad push to diversify boardrooms, there have been some notable strides across the last couple of years, but just to maybe reflect a bit on how you think about board service through an intersectional lens.

Adaeze Enekwechi 32:36
You know, I, my icon is as comfortable in my skin as I can possibly be. Because, you know, I don’t really think of myself as components. I don’t know if anybody does, but I’m a whole person. But in my experience, we started off talking about the fact that I’m a first generation American child of immigrants, right, it is part of who I am. And it is very likely. And in fact, it has happened on many occasions that how I see a problem, or how I hear the difference in how I hear the definition of a problem, or the articulation of an issue is different, is going to be quite different from someone who has not had some of the experiences I’ve had as a black woman, I’ve, my friends know this, there isn’t a type of racism that I haven’t experienced or faced, the names all of that. And we can save that for, you know, a different conversation. But it means something, I think when you are able to be that representation, I don’t like the fact that we’re still talking about one offs, rights and boards, whether it’s nonprofit, or for profit, we need more. But I come as a whole person that hopefully because by virtue of my my expertise, my training, and my background, right, my lived experience, I can add something to the conversation, to the guidance that we provide to the CEOs in a boardroom, or to the guidance that we provide to the executive team as they go on with their daily work. So that’s how I think about it: be additive, calm, complete, be comfortable in your own skin, everything I have to add is just as valuable as anybody else at that table. And just be okay with that.

Renee DeSilva 34:24
Indeed. All right, final question for you. It’s one then ask all of my guests so you have some time to think about it. But if you could invite two people for a conversation at a table that you curate, who would they be?

Adaeze Enekwechi 34:36
And why? actually found this very difficult? Hard question. So 30 seconds on a history lesson. I would invite any of the first women there’s something called the Abba women’s riot in 1929. In southeast Nigeria, where these evil women, right, these African women rose up against the British looniest institution, because they were being taxed overtaxed really, these are market women who had small businesses. And that was the first documented outright uprising, they killed a number of the British, many of them died, they basically went to war against British colonialists on the issue of taxation without representation, any one of them at the dinner table because that is one of the most profound exhibits of courage that I have ever read. And they happen to be women from where I am from in the world, right? EBO women. So that’s one. I love that. The second one ties also in that bucket for me, but I said no, any one of these women from 1929. The second is MacKenzie Scott, and had to force myself to think about a contemporary person. There’s something really interesting about someone who just maintains this stubborn insistence on living as ordinary life as she can manage, in this age, where everyone is on Instagram, showing various elements of their lives, you know, Twitter, addictions, off Twitter, I’m done. You know, and all the other social media, especially someone with means who has actually a lot to say, not just with that means but about that means Yeah, she is a, she is just a complete anomaly. To me. That is a woman that I would love to sit down and say, Why do you insist on doing this? Of course, she has totally turned philanthropy upside down on her own terms, her own drumbeat, with no fanfare, I find that almost miraculous. Very curious about that. I respect it deeply. And that’s the other person I would have at a dinner table.

Renee DeSilva 36:59
I think that’s a perfect table and I will crash that dinner. That wouldn’t happen. Thank you so much. It’s so good to catch up with you. And hopefully it’ll be in real life soon.

Adaeze Enekwechi 37:10
Yeah. Hopefully. All right. Thank you, Renee.

Renee DeSilva 37:12
Thank you. Thanks again for joining me at the table. The Table is a podcast produced by the Health Management Academy. Make sure you catch future episodes by visiting our website,, or by subscribing on the podcast platform of your choice, and if you have suggestions for topics or guests, I’d love to hear from you. Please drop me a note at I look forward to talking with you soon.