Latino, Hispanic, or of Spanish Origin+ Identified Student Leaders in Medicine

Front matter

John Paul Sanchez

Donald Rodriguez Editors a— i Latino, Hispanic, or of Spanish Origin+ Identified Student Leaders in Medicine

Recognizing More Than 50 years of Presence, Activism, and Leadership

Foreword

Joseph Betancourt, MD, MPH, President, Commonwealth Fund, Associate Professor of Medicine at Harvard Medical School

It was a new world. I had achieved my lifelong dream of beginning the path to becoming a doctor. So much sacrifice from my family, support from friends, and advice from the rare mentor led to this moment, one equally intimidating and inspiring. As a Latino medical student, I quickly noticed three things. First, given my lived experience, it was clear our community had difficulty accessing the health care system, and suffered from it, with higher rates of chronic conditions as one of many prices they paid. This was confirmed not only by the research I reviewed early in my medical education, but also by what I saw firsthand with the Latino patients I began to see in the clinical setting. Second, I realized that by the simple fact that I was bilingual and understood our culture, I had an advantage over my peers. Even without advanced clinical knowledge, my simple and natural ability to communicate with patients of different backgrounds—and especially Spanish-speaking Latino patients—made me an asset on the care teams I was assigned to. Third, and finally, we as a community of Latinos were drastically underrepresented in medical education, and medicine in general. This was clear as day as I looked around at my medical school peers and saw few who liked like me and came from where I came from.

These experiences weren’t unique to me; more importantly, many Latino medical students before me felt of all these things much more acutely, particularly being underrepresented in medicine. There were many trailblazers whose shoulders I stood on, who were the many “firsts” not only in their family like many of us were, but literally were the “first” Latinos in their medical school classes. These courageous students made many sacrifices, often at great personal costs, so that my experience years later would be better as a Latino medical student, and doctor. They worked hard to change medical vi

education so that all students knew how to better care for our community, while also rooting out much of the inherent racism, bias, and stereotypes that were taught about and against our community. In addition, they were tireless in their efforts to assure our communities lived in a social context in which they could thrive and be healthy; that they had equal access to care; and that they received, high-quality, culturally and linguistically competent care in any and all clinical settings.

The Boricua Health Organization (BHO) was one such pioneering effort that I benefitted from greatly. As a medical student BHO made me feel part of a community. BHO gave me the reassurance I needed that the issues I faced I wouldn’t face alone, and the issues I saw and was committed to addressing— including Latino health disparities—would be tackled with the help of others. BHO was inspiring, simply by its existence, and the knowledge that those that came before me thought of creating such an important, meaningful, and worthwhile effort. With this appreciation also came a great sense of responsibility. The responsibility to add my part to the movement and move forward in addressing the challenges that our communities and our patients faced. BHO and similar sister organizations across the country that represented the diversity of Latino medical students did this for all of us, and the evolution and consolidation of these organizations in the Latino Medical Student Association (LMSA) was also a crowning moment for all of us who had been part of the struggle. LMSA was a sign of success, strength, and unity.

This book aims to capture all this and more. It looks at 50 years of Latino presence, activism, and leadership by providing the history, stories, and data that come together to make this compelling movement come alive. Not only do we review the past, and learn about the heroes of those moment, but we review the data, and reflect on the future and where we need to go. It is a major addition to our history, our journey, and our story. Long overdue.

I'll end by dedicating this foreword to one such pioneer and hero—one of the co-founders of BHO and my close friend and mentor—Dr. Emilio Carrillo. It is through benefitting from his wisdom and mentorship that I am where I am today, and so many are where they are. He, BHO, and all of LMSA have done so much good, and touched so many lives, and we need to learn that history and build on it with dedication and commitment. This book will serve as the foundation for that in a time when our communities need us most and we should all be grateful for those who put this together and did the work and sacrificed so much to make us better, and our communities healthier.

UMDNJ-New Jersey Medical Joseph R. Betancourt, MD, MPH School (Alumnus) Newark, NJ, USA

Massachusetts General Hospital Boston, MA, USA

Foreword

Sustainable Development Goals Series

The Sustainable Development Goals Series is Springer Nature’s inaugural cross-imprint book series that addresses and supports the United Nations’ seventeen Sustainable Development Goals. The series fosters comprehensive research focused on these global targets and endeavors to address some of society’s greatest grand challenges. The SDGs are inherently multidisciplinary, and they bring people working across different fields together and working towards a common goal. In this spirit, the Sustainable Development Goals series is the first at Springer Nature to publish books under both the Springer and Palgrave Macmillan imprints, bringing the strengths of our imprints together.

The Sustainable Development Goals Series is organized into eighteen subseries: one subseries based around each of the seventeen respective Sustainable Development Goals, and an eighteenth subseries, “Connecting the Goals,” which serves as a home for volumes addressing multiple goals or studying the SDGs as a whole. Each subseries is guided by an expert Subseries Advisor with years or decades of experience studying and addressing core components of their respective Goal.

The SDG Series has a remit as broad as the SDGs themselves, and contributions are welcome from scientists, academics, policymakers, and researchers working in fields related to any of the seventeen goals. If you are interested in contributing a monograph or curated volume to the series, please contact the Publishers: Zachary Romano [Springer; zachary.romano @ springer.com] and Rachael Ballard [Palgrave Macmillan; rachael.ballard@palgrave.com].

vii

Goal 4: Quality Education

Latina/o/x/e, Hispanic, or of Spanish Origin+ (LHS+) Identified Student Leaders in Medicine: More Than 50 Years of Presence, Activism, and Leadership contributes to several SDGs, with the most pertinent being Goal 4: Quality Education. The mission of this goal is to ensure inclusive and equitable quality education and promote lifelong learning opportunities for all.

The chapters included in this book contribute to SDG4—-specifically, Target 4.7—by discussing opportunities for enhancing U.S. medical education and including detailed accounts of the efforts by the stakeholders of the Latino Medical Student Association (LMSA) and antecedent organizations. This national non-profit organization exists to unite and empower current and future physicians through service, mentorship, and education, to advocate for the improved health of LHS+ communities in the U.S. While this work most directly addresses Target 4.7, we hope that, as the SDGs continue to expand, our book will also contribute to new and/or revised indicators under Targets 4.3 and 4.5. Contributions to the specific targets and indicators of SDG4, previously mentioned, are described in Tables 1 and 2.

Table 1 SDG4 Main Target and Indicator Contributed to by the Book

Target Indicator

4.7: By 2030, ensure that all learners 4.7.1: Extent to which (1) global

acquire the knowledge and skills needed | citizenship education and (2) education for to promote sustainable development, sustainable development are mainstreamed including, among others, through in (a) national education policies; (b) education for sustainable development curricula; (c) teacher education, and (d) and sustainable lifestyles, human rights, student assessment gender equality, promotion of a culture of peace and non-violence, global citizenship and appreciation of cultural diversity and of culture’s contribution to sustainable development

Table 2 SDG4 Additional Targets and Indicators This Book May Contribute to in the

Future

Target

4.3: By 2030, ensure equal access for all women and men to affordable and quality technical, vocational, and tertiary education, including university

Indicator

4.3.1: Participation rate of youth and adults in formal and non-formal education and training in the previous 12 months, by sex

4.5: By 2030, eliminate gender disparities in education and ensure equal access to all levels of education and vocational training for the vulnerable, including persons with disabilities, indigenous peoples, and children in vulnerable situations

4.5.1: Parity indices (female/male, rural/ urban, bottom/top wealth quintile and others such as disability status, indigenous peoples and conflict-affected, as data become available) for all education indicators on this list that can be disaggregated

Goal 4: Quality Education

Open Access Acknowledgment

Open Access of this book was made possible by the generous donations of individual co-authors and the organizations listed below. Our sincerest gratitude for allowing this book to be available to every learner around the globe.

Institutions/Organizations:

Association of American Medical Colleges (AAMC)

Individuals:

David Acosta, MD

Emilio Carrillo, MD, MPH

Edgar Figueroa, MD, MPH

Alvaro Galvis, MD, PhD

Francisco Lucio, JD

Aneeta Mehta, DO

Sunny Nakae, PhD, MSW

Pilar Ortega, MD

Norma Poll-Hunter, PhD

Hector Rasgado-Flores, PhD

Elena Rios, MD, MSPH

Franklyn Rocha-Cabrero, MD

Valerie Romero-Leggott, MD

John Paul Sanchez, MD, MPH

Debora Silva, MD, MEd

Orlando Sola, MD, MPH

Jeff Uribe, MD

Larissa Velez, MD xi

Contents

1 TPO sn: dass he cee. eb eeidhd dee doweteds 1 John Paul Sanchez, Donald Rodriguez, Deion Ellis, and Monica Vela

2 LHS+ Medical Student History and Heritage of the US. Northeast Regions ii56 ce cee suse cece eden ayniaaseces 9 John Paul Sanchez, Amanda Lynn Hernandez, Edgar Figueroa, Jeffrey Uribe, and Emilio Carrillo

3 LHS+ Medical Student History and Heritage of the U.S. Southeast Region... . 1.0.0.0... 0.00 c ccc eens 37 Nicole McManus and Victor Cueto

Chapter 2: LHS+ Medical Student History and Heritage of the U.S. Northeast Region

The Northeast region has the third-largest LHS+ population in the country. Harvard Medical School, with its formation of the Boricua Health Organization (BHO), in 1972, stakes claim to the oldest LHS+ regional medical student organization of the Latino Medical Student Association. The foundation and evolution of BHO to the Boricua Latino Health Organization (BLHO) and

J. P. Sanchez et al.

then National BLHO in the 1990s, was a reflection of LHS+ youth, gathering into a critical mass to succeed in their dream of becoming health professionals and addressing health inequities in their underserved communities. As they entered an unfamiliar homogenous, hierarchical culture, often with limited resources for academic success and defying stereotypes to maintain a positive LHS+ identity, the constant inner whisper of ‘Pa’lante, Siempre Pa’lante’! has led to generations of LHS+ Northeast physician leaders.

Chapter 3: LHS+ Medical Student History and Heritage of the U.S. Southeast Region

The purpose of this chapter is to highlight the history and rapid growth of LHS+ communities in the southeast region. The vast immigration to this region from outside the U.S. and the surrounding events are the context in which the students of the LMSA were raised and planted the seeds for LHS+-identified individuals in medicine. As the region continues to grow, there is hope and evidence that the tide of progress will continue to rise in the Southeast region.

Chapter 4: LHS+ Medical Student History and Heritage of the U.S. Midwest Region

The focus of this chapter is to highlight the path towards the empowerment of Latinos in the U.S. Midwest — both in general and in medicine — through reviews of published literature, statistics, and oral history. Through migration, education, and self-determination, Latinos grew from being an impermanent fixture of the Midwestern labor force in the mid-1800s to a driver of diversity, equity, and inclusion efforts within medicine regionally and nationally in the late 1900s and early 2000s. This chapter recounts the key sociopolitical and cultural factors that brought Latinos to the Midwest, shaped this community’s presence within the region, and catalyzed activism within this community for

1 Introduction increased representation in the physician workforce and improved health outcomes. Lastly, this chapter chronicles the trainee-driven grassroots efforts that culminated in the formation of official medical student organizations. The Latino Medical Student Association (LMSA) that exists as of this chapter’s writing reflects the hard work of Midwest students and physicians and will rely on continuation of these efforts in order to promote a healthier Latino community and a stronger healthcare system for all.

Chapter 5: LHS+ Medical Student History and Heritage of the U.S. Southwest Region

This chapter highlights the unique experiences with access to health care and medical education by LHS+ identified individuals in the U.S. Southwest Region. Since the annexation of the southwest regions’ constitutive states, LHS+ individuals, primarily of Mexican heritage, have endured unique forms of marginalization and discrimination that led to disparities in illness, injuries and deaths in comparison to White individuals. As LHS+ individuals entered the physician workforce, despite academic success, they often faced unique roadblocks in seeking employment. The Chicano movements in the 1960s, in particular students’ demands for educational equity in high schools and colleges in Texas, served as inspiration for medical students to seek similar equity within Southwest medical schools. Over several decades, LHS+ medical students and physicians were able to grow local medical student groups and organize on the regional and national level to ensure LHS+ student specific issues were met.

Chapter 6: LHS+ Medical Student History and Heritage of the U.S. West Region

The history of LMSA West begins in the 1960s with a small group of first-generation premedical Chicano students with a vision of serving those in need and dedicating their lives and careers to ensure everyone has access to basic human necessities including healthcare. When those same students started to enter medical school, they found few students like themselves and no role models. They had to pull themselves up by their bootstraps. They were the change they wanted to see. They created a new organization to provide a safe space for mentorship, support, and professional development for future generations of medical students like themselves. The organization evolved from a strong presence in California and other Western states to a unified network that could support students across the region. Influenced by their Latino heritage, generations of LMSA members have shared the values of comunidad, valor, liderazgo, conocimiento and compromiso. This is the story of the LMSA familia in the West region.