Two former Children's Hospital residents, Quynh Tran, MD, and John Pescetti, MD, help make sure culture and poverty don't prevent Oakland kids from getting quality health care.
When John Pescetti, MD, steps outside La Clinica de la Raza into Oakland's heavily Spanish-speaking Fruitvale district, he often runs into his patients. He chats with them fluently in Spanish on the streets and in local stores. "I feel like we (clinic staff) are part of the fabric of the place," he says.
Quynh Tran, MD, also works at the intersection of the personal and professional. The patients he sees at Oakland Chinatown's Health Services remind him of his parents. "They are the people we are working for," says Dr. Tran. "No health insurance because they're working for their friends. Minimal income. These are the patients that we see, they are why we are working here."
Born in Saigon, Dr. Tran immigrated to Arkansas at age 3 with his parents and two brothers. In Vietnam, his mother was a lawyer and his father an Air Force pilot, but to survive in the United States they worked lesser jobs and moved around.
It takes 10 minutes to drive the three miles separating the two clinics where Drs. Pescetti and Tran work. But the cultural landscape of their patients goes from Mexico to the southern coast of China by way of mainstream America and reaches into the lower steps of the economic ladder. Being familiar with this landscape is what enables the physicians to provide expert, culturally appropriate care to their communities.
For example, Dr. Pescetti's patients may complain of susto. Susto is a folk illness in Latin America with strong psychological overtones defined as a "fright sickness," literally a loss of soul from the body. Nervousness, anorexia, insomnia, listlessness, despondency and involuntary muscle tics are just some of the symptoms that can be attributed to susto, especially in the presence of past trauma.
People living away from home, such as immigrants, are believed to be more susceptible. Also, some think that breast milk might carry susto from mother to child. One mother in Dr. Pescetti's practice fed her baby less breast milk and more formula to avoid susto transmission.
While Dr. Pescetti's Western medicine training tells him there is no scientific evidence to support such concerns, he also knows that beliefs can have a strong hold on parental imaginations. As long as they do no harm, Dr. Pescetti respects and indulges cultural beliefs. Otherwise, he uses them as an opportunity to educate, but never to ridicule.
If ethnic backgrounds set Drs. Pescetti's and Tran's patients apart, then poverty brings them together. At La Clinica, close to half of all patients are uninsured. Medi-Cal recipients make up about 42 percent of clients, 7 percent have private insurance and 2 percent have Medicare. At Asian Health Services, 20 percent are uninsured, 70 percent have Medi-Cal and the remaining 10 percent have other medical insurance.
"The patients understand, they have Medi-Cal, there's hardly anywhere else they can go," Dr. Tran says. "But I still want them to feel that even though there's little choice for them to go somewhere else, to see somebody else, that if something were to happen, we are giving them the best care they can get."
Drs. Pescetti and Tran both completed their medical residencies at Children's Hospital & Research Center at Oakland, where about 30 percent of inpatients on any given day are Spanish-speaking and 65 percent of kids have government insurance.
Both physicians recognize that exposure to the cultural practices of the Bay Area's diverse populations as well as the concerns of disadvantaged families motivated and prepared them for the careers they chose to pursue.
"The good work we're doing here is possible because of the good work Children's is doing," Dr. Pescetti says. "Children's takes that federal money (see sidebar) and funnels it and a very significant proportion of Children's graduates stay in the community, provide basic primary care, and those are the programs that I think are very valuable."