Doc With Rural Background Is A Champion For Community Medicine
Tuesday, April 26, 2011
We'll speak to a Harvard-educated doctor who grew up in a small farming community in the Coachella Valley. Dr. Raul Ruiz, a son of farm workers, now devotes his life to building a pathway for youth from rural communities to become doctors who will return to practice medicine in their home towns.
It's hard enough getting health care if you cant afford health insurance, but imagine living in a community where there is only one doctor for every 9 thousand people.
Dr. Raul Ruiz comes from the Coachella Valley and he is passionate about turning that trend around. He himself broke out of his community's stereotypes and forged a new path that took him to Harvard and back again.
Dr. Raul Ruiz is an emergency physician at Eisenhower Medical Center in Rancho Mirage, California, and founder and director of the Coachella Valley Healthcare Initiative.
ST. JOHN: It's hard enough getting healthcare if you can't afford health insurance, but imagine living in a community where there's only one doctor for every 9000 people. Our guest is doctor Raul Ruiz who comes from the Coachella valley, and he's passionate about turning that trend around. He himself broke out of his community stereotypes and forged a new path that took him to Harvard and back again. So doctor Ruiz, thanks so much for joining us.
RUIZ: Thank you very much, Allison, my name is Raul Ruiz, and I'm very proud to be here.
ST. JOHN: And you are the senior associate dean of community engagement and partnerships at UC Riverside School of Medicine, the founder and director of the Coachella valley healthcare initiative. So let's start with your personal story, and I wanted to ask you, what inspired you to become a doctor in the first place?
RUIZ: Well, my mother inspired me to become a doctor. She was a go to person in the community. She -- a lot of the residents came to her to ask her for advice, and where to go to get medical treatment, she learned self-taught in herbal medicine and folk remedies. And so she really inspired me in helping others. Both my parents worked in the fields. My mother worked picking tomatoes, my father worked mixing machines in the fields about a two-hour drive from San Diego in the Coachella valley. And it wasn't until my father was promoted to work at a packing house that we were able to move out of our trailer and into our home in this rural, low income city of Coachella California. So that was a big step for us. And they always encouraged their children to get a higher education and to go to college ask to get a job indoors so we didn't have to work out doors in a hundred and 20-degree desert heat. So that was very important as well for us.
ST. JOHN: But you said that you decided to be a doctor partly out of rebellion in a sense. And for some people, their parents would be expecting them for a doctor, and they'd rebel and go to something else. You went the other way.
RUIZ: Ne, it was more of a rebellion when was an adolescent. So when I was four and taught in junior high of course it was sort of an attention -- a nice attention that I got with the family and the friends that oh, you know, here he is, he wants to be a doctor, and it felt good. And when I was an adolescent, when I was faced with the challenges and the odds against me, a lot of folks wanted me to go into ROTC or get some mechanical training, going on. So I said I wanted to get an education, I wanted to be a physician, I wasn't gonna let anybody tell me what I could or couldn't do, so I said that was my form of rebellion in saying, no, I was gonna be a physician because I can, and I will, and my community needs it, and I want to help others. So when I was in college and applying to medical school, I wanted to make sure that I wanted to be a physician, that that's what I was committed to, and not necessarily out of a sense of adolescent rebellion. So I'd go home to the Coachella valley and actually work in the farm worker clinic. And I was a phlebotomist there for the summers, and I took care of some patients there, and I just fell in love with it even more.
ST. JOHN: So right from the start, you knew that you wanted to bring those skills back to your home community?
RUIZ: Absolutely absolutely. When you live in a community where there's one physician per 9000 residents issue that's very medically under saved. In the United States, the department of health and human services recommendation for being a medically appropriate recommendation is one physician per 2000. To be considered under served issue it's one physician per 3500. And back then, it was worse. Now there's been a lot of progress by those that have been there, and we've reached one physician per 9000. Which is still very underserved according to the United states' recommendations.
ST. JOHN: What do you think accounts for that?
RUIZ: Well, there's poverty in rural areas, and a lot of physicians like to stay and live where they train or where their family is. And when you have in poor neighborhoods an education rate that has about 50 or 60†percent drop out rate due to poverty and the need to work and help their families in the fields or travel in different places to follow the crops, per se, that contributes to it, but also I think that the goal for the UCR school of medicine, which the mission is to improve health of the California residents issue it's also to create pipeline programs for home grown physician leaders from the under served communities, and also to imprudent person healthcare access in the under served regions with creating residences in the under served communities issue in the rural areas of Riverside, San Bernardino county, in the inland empire, you increase the likelihood of physicians staying in these communities of and so that's part of the solution, and part of the mission of the school medicine.
ST. JOHN: So I guess the first challenge is to get people to feel they can do it. To feel like you did, that you can actually make it in this world, in this academic world. What are you doing to recruit and encourage people in the Coachella valley, to follow in your step, really?
RUIZ: One of the things I did after graduating from Harvard was to go to the different high schools ask talk about the importance of an education, and several students came up to me afterwards asking, oh, I want to be a physician, what do I need to do? And I said, well, you need to take the first step, and you need to e-mail me and set up a time a week, and we can meet. So from that grew a program called the future physician leaders where we train or motivate and mentor students from under served communities who want nothing more than to be physician leaders and come back and serve the community. And we have a partnership within the Coachella valley of it's a very unique program because it was originated as a community based partnership with the different healthcare providers in the area, different physicians, friends, and institutions that are -- were willing to allow the students shadow them in their practice set of so some of our students went in with neurosurgeons, with general surgeons, they shadowed me and my colleagues at the emergency department, they shadowed other physicians in primary care settings. And not only that but we have a program of leadership workshops and lectures and preparing them for their under graduate years in medical school. But the -- but the primary criteria for being involved is community service, is giving back from day one, is being involved. Because I believe that one way that you get students back is you never let them leave. And what I mean by that is you get them involved since -- at the beginning, and being part of the solution, and they know that they're part of the solution because there is a dire need for them to become physicians, then it gives them a higher purpose, a higher calling of wanting to serve their community. And throughout their education, if there's the projects, if there's programs that they can get involved in, and nay see the benefits of pursuing the medical education, then they get more motivated, more interested in becoming physicians, and we help them along that path, and we create that pipeline as well so that they can come back to do residences in the area and eventually serve in the under served communities.
ST. JOHN: Of course, one of the barriers is money of how do you pay for this education? And in your case, you literally went door to door and knocked and asked people.
RUIZ: I did. Yeah, I did. In fact, I wanted to demonstrate to my father that I was serious. We were low income, so it took a burden from us to get into medical school. And so I wanted to demonstrate to my father that I was very serious about being a physician of soap I put on the only church suit that I had when I was in high school, I of a senior at that time, and in the summer, I went around the businesses in the desert, knocking door to door, and I basically created a contract that was a social contract with my community. And I would go to the business owners, and I would say, I'm gonna give you the opportunity to invest in your community by investing in my education because I promise you that after I get my education, I will come back and serve as a physician, and help improve the health and healthcare in the community. And they gave me 20 bucks, 50 buck, I mean we're talking about poor neighborhood, low income communities but what was more important there was not necessarily the 50, hundred dollars that I got at a time but was the belief and the confidence that the business owners in the community had and the willingness for them to support a student likely who came from a family where both my parents didn't have a high school education, where we grew up in poverty, to go and become a physician. And so I'm back home and I'm living that dream, and I'm living that promise.
ST. JOHN: So you've paid them back. That's for sure. Their investment paid off.
RUIZ: Well, I wouldn't say -- I've paid them back.
ST. JOHN: In terms of --
RUIZ: I can do what I can. I'm working in the community, I've created this healthcare initiative where we're trying to bring in organizations, healthcare leaders, students, politicians, policy makers, foundations. Of and drawing attention to the dire need to improve healthcare access. So I'm not content until we have more physicians, I'm not content until we have better access, more insured residents until our community can go without the lack of healthcare in our community. So I'm living the promise right now.
ST. JOHN: Yes. A force for change. So how are you evolving that strategy of getting the community to -- or I don't know where you are getting the people to invest in these new doctors to follow in your footsteps?
RUIZ: Well, there's a lot of social capital that's being built in the community. I think that the healthcare crisis that we have speaks for itself and moves a lot of people who have not been involved. That's a lot of folks who have already been involved. We have champ I don't evens of healthcare in the Coachella valley that have done enormous work since I was in high school and in under grad. However, I think what we're doing now is expanding the collaborative so that we can bring others to the table who have some influence to not only invest financially in this problem, but also with their social capital, and their networks in order to create programs that are needed in the Coachella valley to improve healthcare access.
ST. JOHN: And what are some of the main healthcare challenges in the Coachella valley?
RUIZ: Well, the two main barriers were costs and were the issues relating to the infrastructure. So under costs, a lot of our residents can't afford healthcare.
ST. JOHN: Right.
RUIZ: Over 63†percent of the Coachella valley, and in some communities, over 80†percent, are either uninsured or on Medi-Cal. And I say Medi-Cal, because a lot of institutions and physicians don't accept Medi-Cal residents because of whatever reasons issue low reimbursement rates, etc. So we have a large proportion of uninsured and Medi-Cal that rely on a safety net system, and in the Coachella valley, there's a mismatch between the low amount of safety net facilities and their service capacity to meet the demands of the people that rely on their services. And for example, we mentioned earlier, we have one physician per 9000 residents in certain communities, we have for example in the eastern Coachella valley, 12 emergency department beds serving a population of a hundred and 80000 people. That's one bed available for over 15000 residents. We have very few qualified federal health centers, and when we talk about these clinics, we're not talking about large, two story buildings. We're talking about small clinics with one exam room or five exam rooms. So you can already tell the dire need for improved healthcare access, and healthcare access isn't just being insured or being able to afford it. It's also having to do with cultural comp attendance and the cultural humility, and being welcome, and patient satisfaction, and awareness of resources and transportation. And other issues that the community themselves, through the Coachella valley healthcare initiate itch community forums have identified as barriers to acquiring care.
ST. JOHN: Do you think there should be more incentives for doctors to work in low income communities?
RUIZ: Absolutely, absolutely. I think the personal satisfaction of doing good in the community and increasing value, and holding true to the hippocratic oath, and being able to provide services to those that are in need is very strong moral reason to provide services for the under served. How far, I think that there should also be loan forgiveness. There are some programs like the nation health service core out there, but I think that can be more robust, and it should start as early as an under grad. I believe that we should create some further incentives in employment, in benefits, in housing to provide -- and what not, so that the physicians could and would want to work in these rural, isolated communities of 'cause that's another big barrier. And I think by developing more residence programs and academic institutions that are in these communities like the UCR school of medicine, is intending to do, and will do, then we're moving in that direction.
ST. JOHN: So some of the people that you've recruited to go out and become doctors and then return, I mean, are any of them perhaps not tempted to use this as a ticket to escape to a different lifestyle somewhere else?
RUIZ: Allison, this is what I tell my students.
ST. JOHN: Yeah.
RUIZ: It would be wonderful if they come back to the Coachella valley. But we're talking about students who during the summer if they're not working with me and improving healthcare access with programs and research and projects, they're gonna be working in the fields of a hundred and 20-degree weather to help support their parents and their family. So when we talk about a student in -- who grew up in these conditions and getting them to be a physician, just the fact that they become physician improves economic development and wellness in the community because their families are improved, I mean, I'm helping support my mother in this situation, and the quality of life and our health has improved. So too will their families, whether they live in the Coachella valley or not. But the one thing that I really want to inspire in our students is that wherever they're at, in whatever specialty they do, there is always a way to give back. There is always a way to serve. There is always a way to look out for the vulnerable populations with the enormous amount of responsibility, with their education, and with their intellect, and with their fervor to serve, to improve the wellness of the under served communities, in wherever city, suburb, rural community they live. But like I said, we want them to come back to the inland empire, we want them to come back to the Coachella valley. We want them to come home. That's the main thing. We want them to come home to be with their family, to be with the larger community that's also their family. That was one of my dreams in going to Harvard. I went to Harvard Medical School. From there I wanted to be a leader, and to affect policy, and to be an agent of change in many communities like Coachella as well. So I went to) the Harvard Kennedy School of government, I received a masters in public policy. From there I did my training at the yesterday of Pittsburgh affiliated residence in emergency medicine, I'm an emergency physician. And afterwards I went back to Harvard to get a fellowship in the Harvard humanitarian initiative, and acquired a masters in public health from Harvard school of public health. So when I graduated, I was told I was the first Latino to have three graduate degrees from Harvard. And Harvard does something amazing to you. It opens the doors to the world. And I've been able to practice and serve the extreme poor in Chiapas Mexico co, in Mayan villages with an organization, partners in health, under the leadership of Paul Farmer. I was also able to go immediately after the earthquake in Haiti with Shawn Pen, with the Jenkins-Pen haitian relief organizations as the initial medical director and serve. And there's nothing rewarding than to, in the words of Cesar Chavez, to fulfill what he said, which is the end goal of education should surely be service to others. And so that was -- that was a very -- we're being able to do all of these --
THE COURT: You're actually building in a sense, a model for how to turn the situation around of not having enough doctors in the low income communities. It sounds like your own personal experience is the bases for you to be developing a model to change the whole healthcare situation in the Coachella valley.
RUIZ: Absolutely. I think that with my experiences, when I was working in the clinic in the farm worker clinic, I spent one day a week, four hours a day with this family physicians who is from Coachella went to UCLA and came back, doctor Lorraine Gutierrez, so that is the model of our summer shadow program with our future physician leaders of once a week they go with the physician, four hours a week, for six-week, and so a lot of that personal experience of mine is what I know, because I was in their shoes at one point. And I know what the barriers are, and I know how hard it was to have a friend who was a physician to open those doors, and so I want to be able to provide those for those students.
ST. JOHN: We're speaking with doctor Raul Ruiz, who is the senior associate dean of community engagement and partnership at UC Riverside school of medicine, and also the founder of the future physician leaders program, emergency medicine doctor at Eisenhower medical center. So you have multiple roles. Now, one of the things you're gonna do tonight is be the keynote speaker at planned parenthood's annual dinner. Why is it so important for you to support this organization?
RUIZ: Well, as you know, teen pregnancy increases the risk of that teenager to be a single mother, drop out of high school, unemployed, live in poverty, their sons -- there are studies that show that their sons are more at risk of ended up in jail, their daughters are more at risk of propagating the cycle and becoming teen mothers as well. So supporting planned parenthood is supporting community wellness. It's supporting improved health in the community with prevention services like cervical cancer screening, which is one of the leading causes of death in women throughout the world and also here in the United States. It improves healthcare access with their 19 clinics throughout the Pacific southwest. It's also economic development because these teenagers who, if we prevented teenager pregnancy, we improve a young woman's chance of graduating from college and creating jobs. And it's also -- improves or decreases crime in the community so much it's very slightly, especially for the poor, and hardest to reach neighborhoods throughout the Pacific southwest to support planned parenthood.
ST. JOHN: What is gonna be your message to those at the planned parenthood dinner tonight?
RUIZ: Well, the message tonight is basically the -- that planned parent hood stands for so much for all of these -- all of these wonderful projects and healthcare access, and the time when we have a healthcare crisis that they have stood for empowering our youth, they have stood for being able to reach the hardest to reach places with their health promoter programs, and so it's our time to stand with planned parent hood, it's our time to support them during these times.
ST. JOHN: And when you think about healthcare reform and the legislation that's just passed, do you feel like it's actually gonna make much difference in a community like Coachella valley?
RUIZ: If we're able to improve our capacity to attract federal funding for federal qualified health centers, to improve reimbursement rates. For example, with medicate and Medi-Cal. To improve pipeline programs with the new innovative programs or grants that are award said to innovative programs, then yes, it's possible. But if we go down the path of eliminating funding for programs for planned parenthood, for example, if we go down the path that decreases funding for Medi-Cal programs or Medicare programs, then we're only throwing wood to the fire and making the problem worse.
ST. JOHN: But you feel, after a couple years, is it, that you've been working on the initiative to really bring medical resources back to the Coachella Valley. Do you feel like the tide is turning in that community?
RUIZ: I believe so. I am very hopeful. I am very -- it looks very promising. The attention is definitely there, and we have the right ingredients in that community with all the correct players that are needed in order to make that change, and it's not gonna be one person, it's gonna be the entire community coming together looking out for each other, looking out for their neighbors that's gonna make that difference. So we have the will, so when there's a will, there's a way.
ST. JOHN: How many people do you actually have right now who are looking at what you did and saying maybe I can do that too?
RUIZ: I'm not sure who's out there, but I do know that we have an advisory council with approximately 40 people from leadership positions in the different institutions who want -- who are working to improve healthcare access. And so a lot of the credit, and a lot of the success will be attributed to them working together.
ST. JOHN: Well, we certainly wish you the very best, it sounds like a noble challenge and a hardship to turn around, and you have accomplished so much, and a lot of eyes will be upon you and what your doing, and whether it can be a model for other areas.
RUIZ: I appreciate it. We hope to be a model for other low income communities like ours.
ST. JOHN: Thank you very much. Our guest has been Dr. Raul Ruiz who is the senior associate dean of community engagement and partnerships at UC Riverside's school of medicine, and he's going to be the keynote speak are at planned parenthood's annual dinner tonight at the bay front Hilton. Thanks so much to listening to These Days.
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