From a Small Town in North Carolina, a Young Girl Finds Her Calling in Battling Inequity in Cancer Care

Manali Patel, MD, MPH

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Manali Patel, MD, MPH, Associate Professor of Medicine (Oncology) at Stanford University, grew up in Shelby, a small town in the textile and farming community of Western North Carolina, among mill workers and other blue-collar laborers. The daughter of Indian immigrants, Dr. Patel’s early life was marked by being “the other” in this community.

“When my parents immigrated from India, my dad went to the Philadelphia College of Textile and Science and was offered a higher-paying job either in New York or a higher-level position in Shelby, a small North Carolina town. And so, of course, as an immigrant, he took the higher-level job in hopes for more professional mobility. We were the only immigrant family in the entire county. When I turned 5, my parents decided to start a textile design consulting business, and so my dad started working from home much of the time doing this work. My mom drove an hour to work at a weaving mill, and at night, she worked at a commercial bakery. Having my father at home and my mother working out of the house also differentiated us from others in a community where there were more ‘traditional’ gender roles,” she related.

Manali Patel, MD, MPH


Associate Professor of Medicine (Oncology), Stanford University, Stanford, California


MD, University of North Carolina School of Medicine, Chapel Hill; MPH, University of North Carolina, Chapel Hill


“Our pediatrician, Dr. Minus, embraced us, who we were as a family, and encouraged me to look past some of the obstacles and not let them interfere with my desire to be whatever it was I wanted to be. I was drawn to the nature of helping people in the way that he had helped me. In fact, I wanted to do that for other kids who may have been marginalized in their communities.”

Dr. Patel continued: “My parents had permanent residency status, which added to the tensions. When I was 9 years old, my dad was offered a textile design job in Atlanta, so he’d commute back and forth for 18 months, leaving on Monday and returning on Friday, which had its own set of challenges as my mom was still working full-time too. He eventually turned it down and decided it was best to not move. But during the time he was gone, my siblings and I were latchkey kids. We all took the bus to school, and my sister and I walked my younger brother up the street each morning so he could catch his bus. My parents valued education so much that my mom was able to get home to drive us to and from our after-school activities. Eventually, in 1994, my parents decided to take a risk and start their own textile design business, which they ran out of our garage in Shelby and was quite successful. We didn’t have a lot while we were growing up before then. We traveled to India in the summers to visit family, and witnessing the stark poverty there was an early lesson for me in seeing how fortunate we were in America to have food, a roof over our heads, running water, and how very rich we were, comparatively.”

Education as a Way to Understanding Differences

According to Dr. Patel, her parents believed in the power of education to help people understand and accept cultural differences. “My mom came to school on a number of occasions and educated the teachers and kids about our culture. My mom would wear her traditional sari, and I remember people asking about the “dot on her head,” even though she only wore it for special occasions. My dad volunteered as a soccer referee in the county for kids’ games after school, and, after he was naturalized, began volunteering for the county Board of Elections in this small town. The power of the vote, he would say, is a luxury that many are not offered. He used these opportunities to connect with people and built long-lasting, trusting relationships that allowed for greater acceptance of our families’ differences and that also allowed him to educate others about political and ideologic issues. To this day, my parents still believe that education helps overcome the prejudices that divide people. I was reared in a family that placed a high value on education and literacy as a way not only for self-improvement, but to help better society at large,” she explained.

Asked about her decision to pursue a career in medicine, Dr. Patel responded: “I had a bunch of freak accidents when I was growing up that introduced me to the medical system. As kids, we would ‘pencil fight’ on the school bus. You’d pull off the eraser with your teeth and bite the metal end to make it very sharp; then another kid would hold their pencil horizontally, and you would try to break their pencil by stabbing it with the sharp metal end. If you broke their pencil, then they would have to give you two new pencils. I was in first grade, and, as my seatmate was pulling off the eraser, the bus slammed on the brakes, and the sharp pencil went flying, breaking into millions of pieces in my left eye. I stayed at school the whole day, and the teachers tried to get the wood and lead out of my eye but it was near impossible. It was back when laser surgery had just started, so I was lucky enough to get specialized laser surgery under general anesthesia from Dr. Hannah. I stayed overnight in the hospital; I had to wear an eyepatch for several months, and they weren’t sure I’d regain my eyesight.”

Dr. Patel briefly shared another freak accident from her childhood. “A swing set fell on my head when I was 5 years old at a wedding. I made the mistake of pulling myself out from under it, but there was a screw that cut deeply into my scalp. I had 15 stitches in my scalp.”

Dr. Patel credits her pediatrician, Dr. Minus (since passed away), with being the biggest reason she went into medicine. “He really embraced us, who we were as a family, and encouraged me to look past some of the obstacles and not let them interfere with my desire to be whatever it was I wanted to be,” she said. “I was drawn to the nature of helping people in the way that Dr. Minus and Dr. Hannah had helped me. In fact, I wanted to do that for other kids who may have been marginalized in their communities. Growing up in Shelby and seeing how hard it is for so many people to receive high quality health care shaped my overall career goals.”

A Gifted Student Begins Her Road to Academia

Dr. Patel left her hometown school in 11th grade and enrolled in the North Carolina School of Science and Mathematics (NCSSM), a prestigious 2-year public high school that accepts only the highest level of academic students in the state and focuses on science, mathematics, and technology. “I took this amazing course called Wisdom, Revelation, Reason, and Doubt. One of my classmates was Christina Koch, the astronaut, selected for the Artemis mission to circle the moon. There were so many amazing students, and not only were the science and math classes so incredible, but the humanitarian courses were as well.”

After graduating from NCSSM, Dr. Patel entered the University of North Carolina (UNC) at Chapel Hill on a Morehead Scholarship (now called Morehead-Cain), which was the first merit scholarship established in the United States. In addition to covering all expenses for 4 years of undergraduate education at UNC, the scholarship also includes fully funded summer enrichment activities and funding for independent research, internships, and international study.

“When I went to UNC, I was still steadfast on becoming a doctor. I took a medical anthropology course, and that changed my entire life, really opening my eyes to illness on the public health scale. I decided to double major in Anthropology and spent a year in Australia as part of my honors thesis. There, I was invited to intern at an Aborigine Health Clinic in Darwin. I met with one of the Aborigine leaders who asked me what my dream was and connected me to a doctor in a small, remote, Aborigine community outside of Alice Springs, called Urapuntja. I then caught a ride with an Aborigine Health Worker by jeep 9 hours off the beaten path and observed the crucial significance of culture and trust on health and the foundation of relationships between marginalized communities and doctors.”

Dr. Patel shared a special relationship she had with a Western physician, Dr. Saraswati. “He was born in Melbourne but grew weary of Western medicine and ultimately trained in an Ashram in India. He changed his name to Saraswati and had been living and working in this community for years. He had established meaningful relationships and engendered trustworthiness in the health-care system among the community members,” she explained. “Dr. Saraswati formed a strong bond with the traditional healer and the Aborigine Health Workers and became one with the community. It was a remarkable opportunity to witness how to overcome barriers in the pursuit of equitable health care for an underserved population,” she noted.

An Early Passion for Equity

After the first 2 years in medical school, Dr. ­Patel’s passion about equity in health care led her to another eye-opening experience in a poor and underserved community. “I obtained my Masters in Public Health at UNC and while there learned the importance of community-based participatory research. I spent my practicum in Honduras, helping to train community health workers on Pap smear delivery. Although I had no desire to do anything oncology related, it seemed like the universe was pushing me along a path I didn’t anticipate until now, retrospectively,” she commented.

Dr. Patel continued: “It’s important to note, at the time, there was limited understanding of the connection between HPV [human papillomavirus] and cervical cancer. When I went to Honduras, the community members told us the number one problem was not diabetes, food insecurity, obesity, or domestic violence; it was that so many women in the community were dying of cervical cancer. We had to regroup and consider how to engage community members about Pap smears, gauging their understanding and working together to come up with a solution. We ultimately co-designed a new approach in which we would train community members to conduct pap smears. Together we made wood stirrups and used crude head lamps. We still needed someone to pay for the colposcopies, however. So, we found a local organization that agreed that perhaps doing more prevention may lead to more cost savings. Now, 18 years later, the intervention is fully sustained by the community. It was an invaluable experience that informed much about how I later approached my career,” she shared.

A Winding Road to Oncology

Asked about her ultimate decision to pursue oncology, Dr. Patel replied: “I went to Stanford hoping to become an internal medicine trained primary care physician in North Carolina. However, I’m still at Stanford, and it’s fascinating. I ended up in oncology because during my second month of residency, Dr. Caroline Berube, a hematologist here at Stanford, pulled me aside and asked if I’d ever considered hematology and oncology, noting she felt I had a real talent for the field. And, when you’re pulled aside by a noted clinician who suggests a career path, it affects you.”

Dr. Patel shared another aha moment during her third year of residency. “I decided I needed to reconsider whether oncology was my true calling. As I was making that decision, my mom was diagnosed with breast cancer. Then I met Dr. Frank Stockdale, Professor of Medical Oncology at Stanford, who joined in my mother’s care. It was Dr. Stockdale who spent time with my mom and uncovered that she did not wish to pursue chemotherapy, much to my family’s dismay. Dr. Stockdale was the kind of doctor I wanted to be and is largely responsible for my final decision to become an oncologist.”

A Chance Encounter

According to Dr. Patel, a serendipitous opportunity opened the door for her work in cancer care inequities. “When I started my fellowship, I was very interested in cancer health equity, but I didn’t really find my footing, as there wasn’t a huge push for this kind of work. But one day, I saw this flyer on the door advertising a talk by Dr. Otis Brawley. So I went, and Dr. Kim Rhoads, a general surgeon, who I did not know at the time, was in the crowd and asked a question. After the talk, I introduced myself and said I’d been struggling with finding mentorship in cancer health equity. She took me under her wing throughout my early fellowship days, and I marvel at the work she continues to do. Dr. Heather Wakelee was my clinical mentor in lung cancer and encouraged me to follow my lifelong passions in achieving health equity even though there wasn’t much of a path for this work in oncology at the time. 

Much of my work marries my love of community-based participatory research with the economic and policy pieces that drive health and health care. Dr. Doug Blayney, when he first arrived at Stanford, also encouraged me to ‘embrace my inner fire’ and pointed me to a training opportunity where I learned how to design disruptive health-care delivery interventions [innovative strategies that may enhance convenience, increase patient access, or bring about more efficient care models]. My sister introduced me to a colleague of hers, Dr. Tumaini Coker, a pediatrician, who was redesigning pediatric care. It was Tumaini who mentored me as I applied my training to create health-care interventions that I hoped could improve patient care and overcome some inequities in cancer care,” shared Dr. Patel. 

Busy Schedule, in the Clinic, on the Policy Road

Asked about her current work, Dr. Patel commented: “My clinic on Tuesdays focuses on the delivery of lung cancer care for Veterans at the VA in Palo Alto. I’m very lucky to have this position and am very passionate about caring for honorable servicemen with lung cancer who sacrificed for our nation. I have a lab with 12 amazing staff members at Stanford and have a growing lab at the VA as well, thanks to my VA Chief, Dr. Millie Das. We’ve now combined the labs and meet together. I have three meetings a week with the lab members to discuss various projects. I spend a great deal of my time mentoring and conducting community-engaged research that focuses on improving equitable delivery of value-based cancer care. Much of this research we hope will inform practice change and policy, and the mentorship, I hope, will create a supportive path for trainees and others to conduct this much needed work.”

Dr. Patel talked briefly about a large project her group is about to launch in San Joaquin Valley, an underserved region in California. “It requires being on the road, so I get to travel and meet people and form community relationships,” she said. “Every so often, I go to the governor’s office with amazing cancer advocates. In addition, I volunteer for ASCO and advocate for policies to improve equity. I have a very full schedule, but I love what I do.”

Decompression Time

What does a super busy academic oncologist do to decompress? “I have two kids, aged 6 and 3, who really keep me on my toes. I’m running around after them all the time. And I love music and dancing —salsa dancing, hip-hop dancing—you name it. We’ve turned our dining room into a dance studio, play music, and dance. It’s a lot of fun and a great way to release tension from work. I also run, every other day, love going to the beach, hiking, the outdoors—which is why California has been such a wonderful home for us. But I really love my work in oncology and public health, so I feel very fortunate. Oncology is a great career, with a lot of incredible advances on the way.”