Achieving Impossible Dreams
Can a person thrive in a community ravaged by poverty? Are seemingly impossible dreams attainable?
Gloria Sanchez, MD, grapples with these questions every day, both in her medical practice and while teaching aspiring physicians.
Sanchez is associate program director of the Department of Family Medicine at Harbor–UCLA Medical Center, a publicly funded hospital in Los Angeles. She also oversees UCLA’s PRIME MSIII Primary Care Longitudinal course, which trains medical students to be medical leaders in underserved communities.
The lives of patients Sanchez treats are shaped by social determinants of health—forces that dictate poor health outcomes based on ZIP code more than genetic code. Where you live, work, and play has a profound effect on individual, family, and community health, she says.
“How can someone who doesn’t have a level playing field still attain their goals?” she asks, citing research showing that the stress of social and economic disadvantage contributes to chronic disease. “Poverty can literally change your brain, and your health.”
Noting that Harbor–UCLA Family Medicine’s mission is to advocate for disenfranchised populations, Sanchez says, “That’s why I entered medicine. It may sound impossible, but I’m here to help people attain good health so they can achieve their dreams.”
Seeds of Activism
Sanchez’s approach owes a great deal to liberation medicine—the “conscious, conscientious use of health to promote social justice and human dignity”—as well as the principles taught by her hero, civil and labor rights leader Cesar Chavez. These philosophies, she believes, are more compassionate and comprehensive than traditional medical practice.
“The idea is to ‘accompany’ patients rather than tell them what to do,” she says. “I ask patients how they want things to be different in their lives, as opposed to the paternalistic model of saying, ‘Don’t do that.’ I can talk until I’m blue in the face, but it doesn’t matter unless I find out where the patient is and where they want to go.”
Another area of interest for Sanchez is environmental justice—the concept that environmental hazards such as pollution, the negative effects of industrial facilities, and lack of open spaces disproportionately affect underserved communities.
“Members of my family lived in communities that had fewer advantages, like parks, libraries, and high-performing schools, than ours did,” she explains. “I saw that when a jail or a refinery ended up in their community and not where I lived, it was purely a function of socioeconomics and political forces.”
Her grandparents’ and parents’ involvement with the United Farm Workers movement further influenced her. “I learned how to advocate for worker’s rights, access to health care, and improved education for the workers’ children. I probably carried more picket signs than your average five-year-old,” she says wryly.
That exposure introduced Sanchez to the link between the environment and health at a very young age. Many of her relatives became ill while working in the fields, she says, likely due to pesticides. “It’s very scary as a child to think, ‘The workers were sprayed with chemicals while doing their jobs?’ But that was the practice at the time, and it still is in many parts of the world.”
Environmental health remains a concern for her, as the communities served by Harbor-UCLA are near the Port of Los Angeles, a major transportation corridor—and downwind of a large concentration of refineries that consistently engender harmful air quality.
“These toxic entities need to improve their practices on what they disseminate,” says Sanchez. “The communities I work with have so many poor health outcomes because of what’s released into the air.” She adds that, although not completely immune, the much wealthier areas nearby are upwind and thus less affected by the direct wind patterns from the refineries and the docks.
Her experiences have led Sanchez to take a holistic view of health. “We need to be concerned about what we eat, what’s in the environment, what we breathe, because it can and does affect us negatively,” she says.
The Privilege of Higher Education
Sanchez was born in Santa Ana, Calif., into a large family—“Huge!” she laughs. Her father, who was a migrant worker in his youth, returned from Army service and used the GI Bill to buy a house in Irvine, which had better schools than Santa Ana. “My parents worked really hard to get us into better schools,” Sanchez remembers.
Even at a young age, she noticed that the two neighboring cities were socioeconomically quite different. Santa Ana was, and still is, a predominantly Latino community, with the majority making low wages. By contrast, Irvine’s population was more racially diverse and had a population that was more middle-class.
“Growing up, my parents pointed out the graffiti and trash in Santa Ana and their absence in Irvine,” she recalls. “And then we would go pick up trash and clean graffiti, because that was what you did to create a safe community.”
The first of her siblings to attend college, Sanchez enrolled as a pre-med student at Stanford University, where she nearly burned out. “I had no balance. I was working way too much, taking way too many units. I was in this delusional state, thinking I could take a full academic load, work nearly full time, and help my family. I had hoped to not take out student loans. It didn’t work, something had to give.
“Call me a pathological optimist…no matter how difficult your background, with a healthy attitude, advocates, and sacrifice, you can succeed.”
“The privilege and stress of pursuing a higher education was sometimes too much to bear,” she adds. “I felt like I was studying in such an elite place, but I knew and felt guilty that my family was struggling at home.”
A Stanford career counselor named Ruby Mason helped her realize that she could reach her goals—just not all at once. Mason steered Sanchez toward the Minority Medical Education Program (MMEP, now SMDEP), a summer academic program designed to increase the number of underrepresented students accepted to medical school. At the University of Washington site that summer, she learned about career options, how to navigate the application process, and more.
“MMEP was a great way for me to slow down, explore whether medicine was for me, and build self-efficacy. It gave me insight into the culture of medicine, reinforced the importance of balance in life, and really helped me take the leap.”
As a bonus, it introduced her to site director Charlie Garcia, who would become a lifelong mentor and friend. “Charlie Garcia, Lawrence ‘Hy’ Doyle, and so many other advocates are the reason why I am here,” she says. “Charlie was amazing during MMEP, and a big part of why I packed my bags and went to Washington State for medical school. I was fortunate enough to get into other schools, but he made the University of Washington feel like a place where I could succeed.”
Solving the Puzzle
Succeed she did, aided by a heavy dose of determination. “I’m pretty stubborn when I want to be,” Sanchez says. “The Spanish word for it is ‘terca,’ which is slang for very stubborn. Tenacious!”
She also learned to turn routine bigotry on its head. “I worked as a secretary when I was in high school, and this male supervisor in the office called me the ‘cleaning lady’, multiple times! He thought it was funny. That was a source of inspiration to me for years.”
These days, Sanchez shares her experience and knowledge with aspiring physicians at UCLA’s SMDEP site, giving talks on goal setting, prioritization, and on how fulfilling it can be to work in and care for underserved communities.
“I was so excited to see the SMDEP in California,” she says. “It was long overdue. And we are still the only site in the state.”
She has also helped conduct a problem-based learning (PBL) session, which approximates classes that students take in medical school. “PBL is case-based and can really engage students,” she says. “We give them challenging cases and let them solve the puzzle. It’s a great way to motivate the students to think critically and learn.”
Whether mentoring students or treating patients, Sanchez strives for a balance of candor, humor, and kindness.
“I try to instill hope every day, because that’s what these pipeline programs did for me,” she explains. “People like Ruby Mason, Charlie Garcia, Hy Doyle, and many others helped me pick myself up when I was on the floor. They didn’t guarantee me anything, and I don’t think they falsely misled me that it was going to be easy. They gave me hope and compassion. That’s what I try to pass on. I am living my dream as I help keep the pipeline thriving.”
She adds, “Call me a pathological optimist…no matter how difficult your background, with a healthy attitude, advocates, and sacrifice, you can succeed.”