FRESNO — Luisa Valenzuela-Riveros moved from Bogota, Columbia to California’s San Joaquin Valley right before her junior year of high school. She was miserable.
“It was very different from everything I expected,” said the second year UC-Davis medical student who came to the U.S. under the country’s political asylum program. “I had this image that the U.S. was more advanced.”
For the first two years, she hated her small town of Merced. “In Columbia, I was sheltered,” she said. “My parents had good health insurance, and language was not a barrier. When I came here, my parents depended on me to translate at doctor’s appointments.” And because she was an immigrant taking English-as-a-second-language classes, she said her teachers didn’t champion her or her peers — most of them from farm worker families — as college material. She also saw that farm workers lacked access to health care and health education.
But then she left for college at UC-Davis, and she realized her experiences were not universal; they were unique to an impoverished place. And quite frankly, she was ticked off.
“A lot of people think of California as Los Angeles and the Bay Area,” she said. “But there’s this large part of the state that’s extremely poor. Most of what you eat comes from the Central Valley.”
So she applied to San Joaquin Valley PRIME and now plans to return to the valley as a physician. “I was not born and raised there but I would say my heart is in the Central Valley,” said Valenzuela-Riveros. “A lot of passion and drive came from what I saw when I emigrated.”
PRIME — Programs in Medical Education — is a training program at six UC campuses focused on preparing students for health care jobs as clinicians, administrators and policy makers in underserved parts of California.
PRIME Students Form Tight Cohorts
Passion and drive are typical for SJV Prime students. “They all have some sort of deep connection to the valley, a shared experience centered around a place,” said Tonya Fancher, SJV PRIME associate director for curriculum at UC-Davis.”
“The program is so focused on the geography that it allows for a really unique swath of students.”
Take Maricela Rangel-Garcia, a third-year medical student who grew up in Clovis near Fresno.
“I’ve lived here all my life but to be on this side of seeing patients and learning about my community in a different manner than I’m used to has been a real eye opener for me,” she said. “But that’s what I love about the experience. The people I go to school with, we’re all really dedicated to the Central Valley.”
SJV PRIME is a collaborative effort. UC-Merced and UC-Davis fund the program, and special consideration is given to UC-Merced students. UC-Davis Medical School partners with UC-San Francisco, which has been training medical students in Fresno since the 1970s. The hope is that UC-Merced will eventually open its own medical school.
The lack of a medical school in the valley is one reason there’s such a large brain drain, said Kenny Banh, site director for UC-Davis clerkships at UCSF-Fresno. To combat this, SJV PRIME students do their third and fourth year rotations with UCSF at Community Regional Medical Center in Fresno. Typically UC-Davis students do their rotations in Davis or Sacramento.
“With SJV PRIME, not only are kids from here, but they spend the second half of medical school here,” said Banh.
Rangel-Garcia is starting her third year and can already see there’s a physician shortage. “People wait a long time to see a physician and with the transition [to the Affordable Care Act] people have insurance but no physician to see.”
Keeping Valley Connection During Medical School
One of the challenges is maintaining that valley connection for the first two years when students are at Davis, said Fancher. One strategy is to have first-year students spend a day working at a no-cost clinic in the valley such as the Tzu Chi clinic in Fresno. The students also attend monthly workshops that cover a variety of topics integral to the SJV PRIME mission of instilling leadership in the valley.
In addition, students do their clinical requirements for the first two years at Kaiser in Stockton and Modesto. “That’s the closest we can get and still be able to come back to UC-Davis for classes in the afternoon,” said Fancher.
The physicians they work with become powerful role models, Fancher added, because they also made the choice to work in the valley. “It’s the best thing we can do until there is a freestanding program in the valley,” she said referring to the possibility of a medical school at UC-Merced.
Overwhelming Needs in the Valley
Christina Thabit, 28, said when she applied to Davis four years ago, SJV PRIME was brand new. “And I thought, it’s like me in a nutshell. I just applied to it because it summed up all the reasons why I wanted to go to medical school.”
Her grandparents were dairy farmers in Tulare. “My grandpa was always into community service; for him it was the Latino community,” she said. “It wasn’t whether you wanted to, it was how you were going to do it, your obligation to give back.”
Thabit said it is sometimes overwhelming working at Community. “I feel like every single patient has needs. With every encounter, I could relate their story to why there’s disparity in the valley, whether it’s poverty, not speaking the language or not having an education. Every single story has some element of that.”
The experience is sometimes bittersweet. Thabit gets to make a difference in in the community she knows and loves, but it’s also sad because she realizes she can only do so much.
Rangel-Garcia agrees. Her first rotation was in obstetrics and gynecology. She’s already seen patients delivering pre-term because they’re addicted to methamphetamine, a huge problem in the valley.
“There’s a lot of poverty here,” she said. “I’m seeing the hardships people face living in poverty, and how it affects people’s health.” She sees a lot of room for growth and change. “One of our responsibilities in this program is not just being trained, but being advocates for the community, leaders in health care in the valley.”