{"@context":"http://iiif.io/api/presentation/3/context.json","id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/iiif/707wm15n7g/manifest","type":"Manifest","label":{"en":["Dr. Eve Covas"]},"logo":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","metadata":[{"label":{"en":["Rights Statement"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine.  Disclaimer:  The views presented in this broadcast are the speaker’s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice. \u003c/p\u003e"]}},{"label":{"en":["Date"]},"value":{"en":["2016-09-15 (created)"]}},{"label":{"en":["Type"]},"value":{"en":["Oral History"]}},{"label":{"en":["Agent"]},"value":{"en":["Sam Taggart (Interviewer)"]}},{"label":{"en":["Format"]},"value":{"en":["video file"]}},{"label":{"en":["Keyword"]},"value":{"en":["Rural Medicine","Arkansas","Family Medicine","Family Physician"]}},{"label":{"en":["Subject"]},"value":{"en":["Eva Covas, MD (personal name)"]}},{"label":{"en":["Language"]},"value":{"en":["English (primary)"]}}],"requiredStatement":{"label":{"en":["Attribution"]},"value":{"en":["\u003cp\u003eThis item is protected by U.S. copyright and related rights. It is being made available by the Center for the History of Family Medicine as its rights-holder for noncommercial use, including sharing and adapting the work. No permission is required for noncommercial use so long as attribution is provided. All other uses require permission from the Center for the History of Family Medicine. \u0026nbsp;Disclaimer: \u0026nbsp;The views presented in this broadcast are the speaker\u0026rsquo;s own and do not represent those of CHFM or the AAFP Foundation. The information presented is for general, educational, or entertainment purposes and should not be considered legal, health, financial, or other advice.\u0026nbsp;\u003c/p\u003e"]}},"provider":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/aboutus","type":"Agent","label":{"en":["Center for the History of Family Medicine"]},"homepage":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/","type":"Text","label":{"en":["Center for the History of Family Medicine"]},"format":"text/html"}],"logo":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/organizations/logo_images/000/000/246/original/CenterForHistoryFamilyMedicine_2c_RGB.png?1773344256","type":"Image"}]}],"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/293/473/small/EveCovasM.D.DVD.mp4_1759336201.jpg?1759336204","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161634/file/293473","type":"Canvas","label":{"en":["Media File 1 of 1 - Eve_Covas_M.D._DVD.mp4"]},"duration":6409.36963,"width":640,"height":360,"thumbnail":[{"id":"https://d9jk7wjtjpu5g.cloudfront.net/collection_resource_files/thumbnails/000/293/473/small/EveCovasM.D.DVD.mp4_1759336201.jpg?1759336204","type":"Image","format":"image/jpeg"}],"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161634/file/293473/content/1","type":"AnnotationPage","items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161634/file/293473/content/1/annotation/1","type":"Annotation","motivation":"painting","body":{"id":"https://aviary-p-centerforthehistoryoffamilymedicine.s3.wasabisys.com/collection_resource_files/resource_files/000/293/473/original/Eve_Covas_M.D._DVD.mp4?1759336170","type":"Video","format":"video/mp4","duration":6409.36963,"width":640,"height":360},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161634/file/293473","metadata":[]}]}],"annotations":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161634/file/293473/transcript/84893","type":"AnnotationPage","label":{"en":["Dr. Eva Covas Interview Transcript [Transcript]"]},"items":[{"id":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161634/file/293473/transcript/84893/annotation/1","type":"Annotation","motivation":"transcribing","body":{"type":"TextualBody","value":"Interview with Dr. Eve Covas    \n\nGood afternoon; my name is Sam Taggart and we are in the office of Dr. Eve Covas of Hope, Arkansas.  Thank you for inviting us into your office.   It is very important for you to remember that this is your interview and we will talk about what you want to talk about.  I have a whole bunch of preset questions, but they are just to get us going.  If you want to go off in one direction or another thinking about something, fee; free to do it as there is no rambling.  Let’s start from the most obvious: \n\n“I just want to clarify that this is not my office; I work for the Cabin Rural Health Service and this is one of their six clinics, which is the Migrant Community Health Center.  But, I sure feel like it is.”  \n\nLet’s begin: Where, when, and what were the circumstances of your birth. \n\n“I was born in New York City on August 6, 1955 and my parents were very happy that I was coming into this world.  I don’t know who would have delivered me, but there were complications.” \n\nWhat kind of work did your parents do?\n\n“Both parents were hard working middle class people and they met in a factor.  Mom used to sew and my father used to repair the sewing machines.”\n\nWhat are your mother and father’s names?\n\n“My mother’s name is Saqadio Morales and she didn’t even know she had that name until she was going to get married and they needed her birth certificate.  All her life, she was called “Millie” which was short for Milagros which means miracle.  Then my father’s name was Ralph Almodovar.  So, my name was Eve Almodovar and that’s what my birth certificate says.”\n\nYou had mentioned earlier when we were talking that you name is not actually Eva, but “Eve” with an “E.”  Talk about that a little bit.\n\n“My mom wanted to make that distinction because there were several Eva’s in the family and because my last name was so long, Almodovar, she didn’t want me to have a lot of trouble learning to write my name.  So, she decided to make a short name and it was “Eve” as in Christmas Eve.  If were to be a male, it would be Al; so, it was going to be Al or Eve.  Funny when I go to El Dorado, Arkansas, the nurses there were having trouble pronouncing my last name as Almodovar and guess what I was called; “Dr. Al.”  It was almost meant to be right?”  In Puerto Rico, you have to have the maternal name or it’s considered….and my mother’s last name was Morales; but on my birth certificate because as I was in New York and as you know we don’t \n\n\n\ncarry the mother’s maiden name, so it was Eva Almodovar.  But when I get to Puerto Rico with the licensenger, it would seem that it would be a bustard if you don’t have both last names.”\n\nTalk a little bit about how your family came to be in New York City and where you lived in New York.\n\n“Ok, well the one I really know about more is my mom.  She came from a family of eight and her father owned lots of land. He was a very strong character and very distinguished in his community and he was involved in politics to that degree.  My grandmother, his wife, used to have a charity once a month and give out clothes and food to the poor; so that was the environment my mother grew up in.”\n\nThis was in Puerto Rico?\n\n“This was in Puerto Rico and they used to have a cook and someone who would clean the house.  Mom only had to worry about the garden and stuff like that.  When my grandmother passed away, that’s when my grandfather got more into politics and when he died, everything got divided and such.  She was the youngest, so they decided to send her to her godmother.  In the Catholic custom, your baptismal godmother represents that if something happens to you, she would take on.  Mom never knew the lady and she winds up going to New York.”\n\nWas she an aunt or an extended family of some sort?\n\n“Nothing; had never met her or no relationship.  She had no idea what she was getting into.  It was a drastic change.  First of all, the plane crashes and one of the ladies that was in the plane, the seats were wood back in those days and they wind up in Florida.  Her godmother had requested Puerto Rican cheese, shrimp, and lobster and mom came in suitcases with all that kind of stuff.  When the plane came down, there were tears and there was this, what she describes as a beautiful lady with this big hat and she said, “One of these days, I want a hat like that” and the lady had a little baby in her arms when the accident happened and her body crushed the baby.  The lady died and there was blood; it was quite devastating.  Stranded there and they were hungry, mom opened up the suitcases and said, “Eat, feast, happy” and mom could not eat a bite.  She was nervous; she was 15 and all she had was $11.00 in her purse as that’s what they sent her to New York with.”\n\nSo did she crash in Miami?\n\n“I imagine so. They offered a connection flight and she said, “Oh no birds, the sky is for the birds; no.”  It took three days to get to New York on, I think, a bus.  So from there, she sent a telegram and was left with like $3.00 from when she had left.  The story of how she gets on a trolley car and winds up in this little apartment with that godmother and the first thing they tell her is, “You’re here and if you don’t work, you don’t eat.”\n\n\nThis would have been about what year, do you know?\n\n“Mom was born in 1930 and it was somewhere around ’45 or somewhere around there.  At that time social security numbers were and there was the post-depression era.  There were lines of people looking for jobs and so, mom got lip stick to look older and all that kind of stuff, and on lines.  Then they would have her work and she was assigned a number; they would even get your name to see whether or not you did well and then when the inspectors would come, mom would be shuffled into the bathroom because she obviously looked much younger than what she was supposed to.  She went through many different jobs and at each one she tried the very best of what she was doing.  Eventually, she gets to live independent from this lady and she opens the door to her other siblings that came and wanted to….Puerto Rico was having, like lots of people in the depression, trouble.   So then she worked in the sewing factory and my father was the one who repaired it and she was very agile on it.  Subsequently, she worked also a waitress in White Castle at that time and for, I think, it was three consecutive years, she got recognition as the employee of the exceptional and had even a paper on it that she saved very proudly and that kind of stuff.  She went to night school and then later on was the head seamstress to a show room in Manhattan where they would come; the fashion buyers.  So, she absented into that.  When she went to Puerto Rico there, she had finished her high school and started working in the operating room as escort.  She started taking blood pressures and assisting the nurses.”\n\nI think you said that she made the decision to go back to Puerto Rico at one point.\n\n“Oh yeah; after my father left, she wins the New York State Lottery and she says, “Ok, enough with the cold weather here; we’re leaving.”      \n\nLiterally, she won the lottery? \n\n“She won the lottery; the New York State Lottery.”\n\nHow many children were there at this point?\n\n“It’s just myself; I’m the only daughter.  So, that’s when we end up going to Puerto Rico.”  \n\nAnd how old were you at that point?\n\n“Seventeen and I remember saying, “Oh mom, I want to go back” because, I couldn’t express teenagers; you know, there are so many feelings and things and I just didn’t have anybody to talk it with.  Most of them spoke Spanish and I didn’t know how to speak Spanish.  I’d misinterpret words and instead of sugar, I’d say salt and a bunch of stuff like that.  I was blessed; in that neighborhood, there was a retired academian who was in fact the President of the University who was 78 years old at that time and so after school, I would go and visit with him and he taught me Spanish.  He helped me and he was so intelligent, so encouraging, and part of him encouraged me to go on and to the university.  I saw how my parents struggled, \n\n\nespecially how my mother struggled and I knew whatever…I wanted to go to college.  When I do go to college, thank goodness I did learn enough Spanish to get into the entrance examination.  The first year is all basics and I still didn’t know what I was going to go into.  Then I made that decision as I says, “Dear Lord, you know what my virtues are, what my talents are; you put me where you need to.  Show me the way and if it’s not to be, make it very difficult so that I know, nuh uh, move on.”   So, the faculty of Natural Sciences would only admit 100 students per year and you had to take an entrance exam; it was the only one that required that or had that stipulation.  So I said, “Let’s go with the most difficult; if I flunk the test, I know that that’s not where I got to go.”  Low and behold, I passed the test.”\n\nWhich University is this?\n\n“This is the University of Puerto Rico.  Then, I finished there.  I take biology thinking “ok, four years, I can go out there and work in that.”  But, I also felt because of the way that I saw my parents struggle and such, I got to select something that has different avenues; different doors as you never know what the future will entail.  So, biology was perfect as you can do medicine and premed and there is so many things; nursing, pharmacy, all that; it can open up many areas.  So when I graduated, I was a scientist and did research in a beautiful garden.”\n\nI don’t mean to interrupt, but we are missing over some things I want to ask you about your childhood. You are doing wonderful; but I want to hear a little bit about elementary school, junior high school, and high school as well as people who had an impact on you in school when you were a kid; it doesn’t have to be teachers, it can be people in your community or neighborhood who had an impact on you pushing you in one direction or another.\n\n“Towards medicine, that came out much later because while I lived in New York, it was more business oriented.   Cathedral High School was more business oriented.  The hustle and bustle and excitement of the city; it’s all a different flavor.”\n\nWhat part of the city did you live in?\n\n“We lived in the Bronx and it was a melting pot of civilization.  We were the only Hispanic family there.  My best friend was Greek.  I had another childhood friend who was Polish.  Irish was the youngest of us and avengers of going to the park and a lot of fantasy playing.  The good thing was entering each one of their homes with a different aroma.  The grandmothers with the different languages; it was so enriching and everyone respected each other.  We were all there for a reason, to live and prosper; that was the common denominator of the neighborhood.”\n\nDid you have a close knit group of friends?\n\n“Yeah; those three mostly.”\n\nDid you stay in contact with those people?\n\n\n“Unfortunately; no, time has passed, no.”   \n\nAny other Puerto Rican friends?\n\n“We were the only Puerto Rican family in that area.  Much later on, there was other Hispanic families and of course, in church.  You have more Hispanics in church and then, you have the Spanish Mass that comes in; but back then, there was nothing like that.”\n\nDid religion, church, play a big role in your life?\n\n“Oh yes; majorly, mom was very strict.”\n\nDoes it still?\n\n“Oh yes; Cornerstone. So, I would say that and the thing about….in the summers, we used to give back to the community with “operation safe plate” to help the other kids.  We tried teaching; I say try because that was very challenging.  I didn’t do that very often.”\n\n What were your main areas, you already said when you went to the University of Puerto Rico you were in natural sciences and biology; did you have any interest in high school or did you  kind of have an interest one way or another?      \n\n“No; high school, everything was more directed towards business and fashion; the city kind of hustle bustle, that kind of stuff, no. if you would have told me that there was such things as cowboys existed, I wouldn’t have believed it because that was Hollywood.”\n\nWhen did you start wishing that you were in Puerto Rico?\n\n“Well I really never wished it, because I didn’t know it until my mother relocated there.  That’s when I learned about our culture.  That’s when I learned Spanish and that’s when I learned about the history of my ancestors.  That’s where I really had a sense of self and of pride of being proud of the roots of Puerto Rico and its relationship with the United States and the richness of Spain and the influence that it had, which is something that you don’t get of course when you grow up in New York.  Other countries and other ethnical groups, I think that would be so wonderful if everyone had that opportunity.  So, that’s where I feel in love with Puerto Rico and that kind of stuff.”\n\nWas it a big culture shock when you moved at age 17 from New York City to Puerto Rico?    \n\n“Yes.”\n\nWhere did you live in Puerto Rico?\n\n“Initially, we lived with my aunt until we were able to get the house and then we lived in Catalina, which is where the airport is located; so it was in the city. It was where my mom had \n\n\nland in the country and I got to meet some of the relatives there.  So, yeah; but later on after I go into medicine and all this, my first real job; like I said “real job” is because I selected it, was you know how we all do ER work right? The word got out and I got into a private company, which was Fahilda Emergency Group and they offered me the job as medical director of the ER in Vieques.  Now, Vieques is a little island that belongs to Puerto Rico now after the Spanish-American War; but before that, it had its own Dutch Domain and a different kind of cultural background.  75% of the island was American military and only 25% was civilian.  There wasn’t one traffic light nor one sky scrapper; I feel in love with the simplicity of life, you could be in jeans and a t-shit any day anywhere and everyone appreciate what you did for them.”\n\nNow, this was after medical school?\n\n“This was after medial school; that was really after doing the basic jobs and such.  But, this was, I think, my rewarding in life; was there, it was so exciting.  Because first of all, it was Spanish hospital; if you can recall, Mahogany doors real high and those Italian kind of tiles, black and white; then it had a wing on the right that was all for the men and a wing on the left, just like the old movies where you had one bed right next to the other and for privacy, you had these screens that are hung with cloth, it was neat as all get out, and then there was two to give privacy.”\n\nI’ve been to places like that.\n\n“Although you were doing ER work, because there was no hospital and this was pretty much an ER quick care kind of stuff; if needed an MRI or they needed an ICU consultation, you had to get on a plane, which was Vieques Airline, and then correlate with emergency services so that they would pick up your patient. You would have to escort them to there and arrange for that kind of specialty care; so lots of exciting things happened on those planes.  Oh my goodness, that was exciting.”\n\nDid you ever ride over with the patient?\n\n“Yes, that’s where it was just rewarding, I mean.  And I think that that is one of the reasons why when I decided to stay here, I was ready.  Because I had done so much exciting things there and I saw so much, improvised; so by the time I get to Arkansas, I’m ready to settle down.”            \n\nDid you take a car to that island?\n\n“No.”\n\nCan you take a car?\n\n“Oh you can take your car through a ferry; of course.”\n\nYes; did you do that or did you just walk around?\n\n\n“Well, there is Vieques Air link; it had a little airport and you commuted on weekends or whenever you could, you commuted on that.”\n\nSo you lived on the main island?\n\n“No, I lived in Vieques; right there.  The Fahilda Emergency Group, the company for which I lived, I worked for.  They had at the beginning this, the word escapes me right now, but it’s like a nice hotel facing the ocean and you got room service and all this, but they had that contracted and plus they had a vehicle; a parador. After the hurricane, Hurricane Hugo comes in; it was completely destroyed.  So then, I got an apartment closer to the hospital.  I really enjoyed that better; being closer to the hospital and then I had more neighbors, it was more homey and down to earth kind of stuff.”      \n\n How big is Vieques?\n\n“Oh I don’t recall.  It’s much small than Puerto Rico; much smaller.  But the interesting part of it is that you get all these emergencies and you’d have to get on the plane and the surprising things that would happen.  For example; there was this one elderly man that was found unconscious and was brought in.  We are able to run CBCs and check his vital signs; we have a chest x-ray and that was fine, but he was not coming to.  So, of course we need the CT of the head finally to find out what is going on with his brain.  We get on the plane and when we would use the plane what they would do is remove all the seats and I think that plane would get maybe 12-18 passengers usually; it was a small one.  And then they would hook the stretcher and lock into a beam, kind of that it had, and you had one chair that was next to him and that would be the door that enters and exits.  Then there is a curtain where you would put luggage and stuff there and you could see the pilot and the copilot if there was one; usually there wasn’t one. So, I’m here and we’re in the air and I remember having a pen in my ear.  He’s got IV fluids hanging there and I’m sitting right next to him watching him when all of the sudden we’re in the middle of the air and the door opens.  You feel the breeze come in right and then he wakes up.  All of the sudden he starts tugging on me and pulling on me and I’m  trying to grab the door and then the pen goes down and I see it go down…..all the way down.”\n\nThat’s pretty exciting.\n\n“Yeah, it was; stuff like that was really funny.  Then I remember another time, we had a woman who was pregnant and she was maybe 3cm.  The rule was that if they were less than 4cm, they had to leave; you had to have back up and all that kind of stuff at an adequate facility.  If it was greater than 4 or 5, they stayed because by the time you’d get there they would be ready.  Well this woman, when we go, at the moment of landing or the process of them doing the circle at the airport; the airport is between two mountains and they have to circle around to get the stretch to land in and in that moment, she really gets into heavy labor right there.  So, I’m there \n\n\nand the lady is in position and such and I got her all draped as we get prepared.  As she was going, I noticed and examined her; she was dilating faster than what we thought.  So, I had her all dressed up and ready and all this.  When we were about to land down, that’s when the baby starts coming down.  There was nothing holding me back and I just go right in with everything.  Oh my gosh, that was really crazy.”\n\n You had some real air adventures; didn’t you?\n\n“Let me just tell you the last, the last, the last…..the most exciting thing was at the very end before the hurricane over there; it turns out and it was exciting because I was able to prepare with the Governor, or the Mayor rather of the island, the disaster planning. We had areas prepared with nursing and basic staff and she went on in the shore and got everybody out of the home that were right by the shore.  We prepared the ER and people started arriving; especially those that didn’t have anybody to take care of them.  They were dropping them off in the ER as we had those two wings.  I was full, so when the hurricane comes, everything is real nice and quiet and then all of the sudden; the winds come and everybody is huddled together and the top roof, the doors opened and water is just gushing down that stairway filling in.  So, we huddled on together and I get everybody away from the windows.  Those two wings were like an “L” one side and one side and all that was windows.  So, that was very dangerous to have even though they were all boarded. So we are all huddled there and when the eye comes, there is quiet and I get this call in that there is this woman who is in active labor.  So, I give them instructions and say, “Ok, this is what you’re going to do” and when the second half of the hurricane came, it stops.  So, then when it finishes; they bring her in.  The place is devastated; there’s trees and everything and they can’t get the car though.  Would you believe they created a hammock and they brought her in the hammock carried by people?  Then, we were able because beforehand we had the military; the Navy was contacted and they were the ones that helped us to get her to a hospital because she had been in labor over 24 hours already and you know, C-section.”\n\nDid you do c-sections there then or have to ship them out?\n\n“No, we had to ship them out; there was no anesthesia there.  The air embolisms; that was exciting too.  They would come in and their skin all molted and aching all over.  You had to put their head down and legs up; get a fluid of Ibuprofen and all this and then try to find a decompression chamber.  Ok, the closest decompression chamber was Sava, which is Puerto Rico.  So, if the military is in active exercise, you can’t you’re their decompression chamber; that’s what happened.  We couldn’t use the one that was in Florida either, so do you know where we ended up? In Cuba.  I had to get my patient there; so it had to be an airplane that could sustain a certain amount of pressure.  So, the Army sends us a Hercules plane.  When it lands into Camp Garcia, which is one of the military camp areas, to load the plane it opens up and you roll on in there.  That was exciting to get there.”\n\n\nWhat kind of time frame do you have to do something with air embolism?  How quickly do you have to get something done? \n\n“As soon as possible.”\n\nAre there hotels on the island where people would come to vacation?   \n\n“Oh yes.”\n\nDo they dive?\n\n“Oh yes, yes.  The fishing was their main resource of income and the nice thing is after that came and he got better, he comes back and as gratitude gets us a barrel full of lobsters.  There was a big party.  The beauty of the people, like that lady who was pregnant and they couldn’t get it; do you know also the people made a circle with flashlights because it was dark; hands everybody pulled in together so that the helicopter that was flying in could land.  It’s really rewarding to see how people all pull together.”                     \n\nLet’s go back and pick up a few of the things that we’ve already gone passed.  I would like to get the times and dates of if you can.  Like when did you graduate from high school and where did you graduate from high school?  Also which years were you on the island?\n\n“On the island; I left in ’91 when I came to Arkansas”.\n\nBut you started there out of med school or your residency?\n\n“No, it was….I’d have to add that up.  Well, I didn’t graduate from Cathedral High School, which was one of the reasons why I didn’t want to leave because if you graduate from Cathedral High School you get the privilege of being able to be married at St Patrick Cathedral.  I went to St. Antonio in Puerto Rico that last year.”\n\nWhen did you graduate; what year was that?\n\n“Well, we went to Puerto Rico in ’72, so it must have been in ’73.”\n\nAnd then you went to college at the University of Puerto Rico.\n\n“Uh huh.”\n\nI just want to get back and get these back in record.  So, did you graduate from the University of Puerto Rico?\n\n“Yes.”\n\nDid you go straight to medical school?\n\n\n“No, I didn’t go straight to medical school.”\n\nWhen did you graduate from the University of Puerto Rico?\n\n“Four years later; that was ‘77.”\n\nWas there ever any question; you mentioned earlier about your thoughts about going into medical school, when did you decide that you really wanted to go to medical school?\n\n“I never thought I would go to medical school; the thing about biology and making sure that it had premed was because premed was used also for pharmacy, nursing, and any medical alive post graduate; but, I never really thought of being a doctor.  As a matter of fact; you know, I thought I couldn’t be a doctor as, “That’s out of my league and I don’t have the money for that or anything like that.”         \n\nDid you excel in your academics?\n\n“Yes, I did.  I graduated Cum Laude.”\n\nAt some point during this process, you obviously had to start thinking about “I’m going to go to medical school.”\n\n“No; when that happened, I was working as what they called their interviewer in epidemiology for Central Latino Mexicano  Infirmalous Dermercion Sixone, which is a Latin-American Center for sexually transmittable disease and it was opening; it was new and part of the medical center there, which is a big teaching hospital there too.  They operate under the guideline of the CDC.  So, I worked and was assigned to a division which is mostly tracking your Syphilis and Gonorrhea, and any positive testing that’s done at the prenatal clinics at the Health Department; that kind of stuff, and then you have  to track down the cases.  The division where I was assigned was mostly prostitution and homosexuality; that section was quite prevalent where I was assigned to.”   \n\nWere you in a large city?\n\n“Yes, that was San Quinn; that was the area I was assigned.”\n\nHow long did you do that kind of work?\n\n“Oh, I think maybe three years or so.  My superior thought that I was very gifted and when the opportunity came about for research on pelvic inflammatory disease, he thought of that of me.  It was very rewarding as I got to see different ways of life and what goes through things and stories about…incredible things; people from other countries and the ships, as you know Puerto Rico has that dock right the in ole San Quinn, and lots of cases that came in.  How to communicate by using nonverbal communication and getting the information you needed, \n\n\nwhich later on in this shop was very rewarding also on teaching the staff how to communicate also without having to use words.”\n\nBy this time, had your language skills improved?\n\n“Oh yes, oh yes; by then yes, especially in college.  Oh heavens, yes.  So the basic Spanish, I might be kind of choppy; but in terms of academia, I could speak it much better.”     \n\nYou mentioned your boss saw in you somebody who had potential.\n\n“Yes.”\n\nWould you say that he or she was influential person in your life?\n\n“I would say so; Ortiz was his last name and he is the one who recommended me for that position in the research of pelvic inflammatory disease.  While I was there, one thing I didn’t like about the job was that there was no people connection.  It was mostly research and getting doctors to participate for me to get the Petri-dishes, because that is how we used to do gonorrhea before; the cultures.  Then, I met this doctor who used to come in tired, dragging his feet at 7:00 o’clock in the morning and really we had to be there at 8:00, but I always wanted to be there early because I wanted to get away from the traffic since I lived in Catalina.  Anyway, the thing is that he was the one who was doing private research and that’s why we worked together.  He was retired and was in his 70s already and still he used to see a lot of the prostitutes that worked in that area.  He would care from them like he was their father; a fatherly image.  He was doing the research on trying to define that condoms do not protect you 100% from gonorrhea. He swore that it was a matter of the pores of the latex and that kind of stuff.  He has his own gram stains in the bathroom with his own little lamp.  So, he was the one who told me; he said, “Look” under the situation that we were going through at the area, he says to me,” You are wasting your time here.”  We would talk about the patients about the disease process and all of this and he would say, “You’re more detailed than most in this area, I would encourage you to pursue medicine.”  So, I talked to my mom and she was 100%.  She said, “Look, plant those feet down if you think; what’s the worst thing that can happen; it doesn’t work out, but you try.  And whatever you do in life; give it a try.”\n\nHow old were you?\n\n“30 about; I think I was somewhere in my 30s already.”\n\nWere you married by then?\n\n“No, no.”\n\nDid you have any problems getting accepted to medical school?\n\n\n“No.”       \n\nTalk about medical school a little; talk about that first two years of medical school.  Tell us about medical school in Puerto Rico. \n\n“Alright; the place where I went, it was interesting because the clinical was assigned in the third year.  Third year clinical were the most impressive on me.  At that time, they assigned us to a town, which was Acybil, and at that time, there were no other hospitals.  It was a regional hospital and it covered many towns around it.  So, I would see pathology that would just create all hyenas.  In my third year medical school within two or three weeks, I did 75-80 deliveries.  It was two of us assigned plus an intern and that’s how many people.  We were just running, running, running and you saw all kind.  I even did a vaginal twin delivery because there was no other choice; it was going to happen and it went quite smoothly; I was so happy to see that.”\n\nHow much OB experience had you had already at that point?\n\n“That was it; that’s how I started.  So, yeah; that’s how my love for OB really started.  Then, when I had the hurricane there at Vieques; that’s when I decided that I needed to do something different, but I didn’t know what.  When I hear about Arkansas having a residency program in family practice, because I like the diversity of things, but I had that romance of OB; they tell me that there is this residency in El Dorado, Arkansas that they do…..”\n\nDid you have any idea of where El Dorado, Arkansas was?\n\n“No…and that it does have obstetrics; I go into the interview thinking that as competitive as it is in Puerto Rico, which is highly competitive and family practice doesn’t touch OB because you’re competing in OBGYN territory and that kind of stuff, but here…when I tell them my experience, I think it was like 7 years that I was already in the ER, and all the things that I had done; I remember being in a suit thinking “they are really going to scrutinize me and all that” and it was Dr. Sarnickey who interviewed me.  There was another doctor who was in the residency, Joy Mada, and when I was in medical school, the policy was that you would take under your wing the year following you; so, she was the one who was assigned to me.  I felt like I was her teacher, or guardian, or something like that.  It turned out that she was in this residency and that’s how I come in.  Unfortunately; and she tells me that we could share the apartment and all this and I thought, “oh wonderful, maybe that is the sign; right?” Well, I go; like I had said, first you put your hands in God and you ask him to take over your life and to show you the way and to let you know if you’re on the right way.”  That day that I take the plane from Vieques to come to Arkansas, eventually, would you believe I share a seat right next to me a military guy who, I don’t know why he was in a layman aircraft when they have military flights separate, but he was coming to El Dorado, Arkansas.  Not only that, his mother worked as an instrumentist assistant to a surgeon in the Union hospital.  When I find that out, I said, “Oh God” and chills went up and I says, “This is a sign.”  I mean how can you not say that you’re not in the right \n\n\nplace there.  Then unfortunately when I get here, Joy Mada’s brother who had just graduated from law school was driving; it was raining and he crashes and dies.  So, Mada was devastated and she had to leave; but then I was alone.  Dr. Carroll was just so wonderful with me too and supportive.  I bring my mother in to live with me; but in the meantime, I was working the ERs because of course I had full license to being with and there’s reporcosity with Puerto Rico.  So while I was working there, Dr. Floss who was with AHEC, with CABUN; offers me a job in the night clinics for CABUN.  They used to have to do night clinics and the residents were able to do that; so that was one way.  I was working a full shift at the ER and then have to continue with the residency to be able to support myself and my mother back at home.  It was lying heavy.”\n\nI’m a little confused so let’s back up just a little bit.  You graduated from medical school and when did you do the island work?\n\n“I graduated in 1985; then I did the internship, which was separate.  I did the year of public service on the island in a facility that was in the rain forest.  The prisoners there were so grateful for the intervention that I did that they would bring me little gifts from the forest like orchids and stuff like that.”\n\nNow this was your one year of public service?\n\n“Yeah.”\n\nHow far was that from San Quinn? \n\n“Uh, two hours; it might be an hour and half in traffic.  But I was living not in San Quinn, but in Catalina.”\n\nThat’ was after your internship.\n\n“Yes; in Fahilda, that’s where I ended up doing my internship. Then there, I worked for the public health system after that in Hugo Grandees another facility.”\n\nHow long did you do that?\n\n“I don’t recall; one or two years, something like that.  While I was doing that, I did the ER and so, that’s how the Fahilda Emergency Group got to know me.  Then, they offered me that job in Vieques.”               \n\nSo you had at least four or five years worth of post graduate work before you came and did the family practice residency.\n\n“Oh much more; yeah.  You know, I had done so many other things.”       \n\nThat really would have put you way ahead of a lot of the residents; in terms of experience and the kind of things that you could do and had already done.\n\n\n“I was always kind of a mother hen; uh huh.”\n\nDid others start to look to you?\n\n‘Yes, I had several.  There was a Dr. Fredrigas, I remember, whenever he’d be in the ER and was doing something I’d tell him, “Look, this is what we do; do this and you’ll see how it works out.”\n\nDid you find any real differences between what you were doing in Puerto Rico and say what Dr. Carroll did from an OB standpoint?\n\n“No; no.  Well, it’s a whole different ball game in the sense that my exposure was more GP, you see; but we didn’t do c-sections; I would assist, but no I didn’t do c-sections.  Dr. Carroll; no, he did c-sections, tubals, and D\u0026Cs.  Yeah, I remember thinking, “Oh my God, we’re going to do what?” and Carroll was like, “Come on” encouraging me.  He was very positive and so, yeah; the conclusion really is that when I came to Arkansas, it’s like a melting and it gives me a meaning when I hear about this job.  It’s just means that this is the purpose of all my life.  Why was I born in New York and feel so comfortable with the United States speaking English so naturally?  Why I had to go to Puerto Rico and learn Spanish and all this and have the experience?  Go to Arkansas because the catch was obstetrics and then I take a job this is not obstetric?  Why, because it felt like this is where God wanted me to be.  This was exactly where my calling was and that I had done all the exciting stuff already and I’m ready to settle down and just serve.  Serve what; a population that needs me, a population that appreciates it.  That is the number one rewarding thing; that is the thing about the farm workers, they are out here to work.  They are out here and need help because their health is very important to them and they will do what needs to be done to take care of it.  But, their resources are limited and many of them don’t have private insurances and they don’t qualify for Medicaid.  They might not have that social security number and you have then CABUN, an association like that, that has the sliding fee that is able to help those who are the backbones of America; who are out there bending their backs and getting the sun who are giving back.  It gave meaning to my life and purpose.”\n\nI really want to spend some time talking about CABUN; but I got one thing I want to ask you before we get to that…you moved from New York City to Puerto Rico, a big culture shock; you moved from Puerto Rico to Vieques, a little island; and then to El Dorado, Arkansas; South Arkansas.  Talk about that cultural shift.\n\n“Well, the big blessing is that down here in the south; there is such warmth.  That was very welcoming; in terms of that, I felt at home.”     \n\n Did you have that before you came here?\n\n“No; I also learned about hunting and that was incredible.  I learned about cowboy hats and boots and yes, line dancing; yes.  So, the cooking and I loved it.”\n\n\nYou used the word CABUN several times; can you talk about the name CABUN and what it stands for?\n\n“It’s Calhoun, Bradley, Union, Nevada; serving that area.”\n\nAnd what kind of organization is it?\n\n“It’s a community health center; one of several of Arkansas.”\n\nSimilar to ARcare.\n\n“Exactly, but it is divided; it’s in charge or assigned south west; it takes care of the south west part.  Like having a pie and they’re all divided in separate areas and so this is CABUN Rural health.”\n\nAt what point during your training did you become aware of the fact that this existed and that you might start working here?                \n\n“Well, I did; I think it was in my second year of residency that I started doing the night clinics in Strong, Arkansas and then shortly after that, the Governor commissioned for minority health and addressed for the need for medical care in the farm labor center rest stop through the employment security division.”\n\nBy the way, that’s where we are right now.\n\n“Yes.”\n\nThat original facility was over on Hwy 67, but we are at that place.\n\n“Exactly; so they then because of its location I presume, addressed then CABUN to suffice that need.  So CABUN, because I was an employee already, when I started working the Strong Clinic, there was in Hermitage a tomato farm, or something like that, and a lot of their workers started coming to that night clinic.  It was kind of coined to the Mexican night because then a lot of Hispanics were there; you know.  Usually, if they speak Spanish they are called Mexican, but we all know that there is a great diversity.  So, my obstetric clinic also, “oh, they spoke Spanish” in my clinic; so, that kind of relationship was boiling and growing there.  So, naturally when CABUN gets approached, they think of me and they ask me if I would help open the medical facility for the farm-labor center; the migrant workers.”\n\nBefore you came on board, what happens if a Hispanic woman who does not speak English or any other language; what happens when she goes to a facility and she is pregnant and they don’t have a Spanish interrupter?  What happens?   \n\n“Well, I’m sure that there is nonverbal communication, which is readily available.  I would guess this means “I’m pregnant” (circling her hand out over her stomach) and you know, they will \n\n\nalready know that there is a baby in the bun and we’re there for that.  Plus, there is always some sort of resource to try to get the communication; someone that might speak Spanish.  I don’t think that the telephone line was readily available for a translator to be very popular back then.  But yeah, there has always been some way to get it; but not as effective as if when you are able to relate to their culture and their language and they can express; that kind of stuff.”\n\nWhat did they do at the Strong clinic or the clinic at Hermitage before you came along?\n\n“Well, I really don’t know.”   \n\nHire an interrupter or did they have interrupters?\n\n“Probably; the problem with the interrupters is that not always do they have a medical background and the translation might be more interruptive than translated as such; you never know what it is the message that’s coming across.”\n\nDid your residency ever pull you out of a room and say, “please come and interrupt”?                                            \n\n“I don’t believe so, because there was Dr. Fredrigas who also spoke Spanish.  Lots of my colleagues also spoke Spanish, because they were trained in the Dominican Republic; so, yeah.”\n\nYou already said that oftentimes if it was a Hispanic woman, they would send her on ..\n\n“To my area; yeah.”\n\nAre there other medical schools in Puerto Rico?\n\n“Yes.”\n\nHow many?\n\n“Well, I don’t know right now because I hadn’t been there in a while; but there were three at least that I know of.”\n\nDid you consider any other medical school other than the University of Puerto Rico?\n\n“No.”\n\nWas it the University of Puerto Rico?\n\n“It was ____________________________St. John the Baptist School of Medicine and the professors from the school, what would be like UAMS, would give class to this school at night.  It was the same professors.”\n\nSo when you came to do the residency, did you have to take any other exams like the FMG?\n\n“No, because it’s not a foreign country.”\n\n \n\nSo when did you finish your residency?\n\n“Um; 1991 when I came here.”\n\nTalk a little bit about the migrant worker center that you first came to and looked at and said, “Ok, this is where I’m going to work.”  I think you said it was a facility located of Hwy 67; it wasn’t a large facility, right?\n\n“Well, it wasn’t really a facility.  Because of the generosity of the education department that was involved with…well, first of all; the farmland labor center was a rest stop and its purpose was so that America’s farm workers could have a place to rest, right and secure; because there was a lot of problems with cars breaking down and people being assaulted in rest areas; tragedies.  So, the work force wanted to give them a secure place; that was the main purpose. Second, they got the education department involved because of the children.  They would get the transcripts from wherever they were and try to get them connected to wherever they were going; also giving them educational tools to be used along the way. When CABUN accepted the assignment, they didn’t have a place.  They didn’t have a structure and it was education that gave them a closet that they had, which would be maybe half the size of a room, maybe a little less, and there they would have just a stretcher, a desk, scales to weigh the patient, and a nurse who would establish the need, and had vouchers.  She would then take them to a doctor or medical facility according to what she would decide where they needed to be to give them the care they needed; it was like a voucher.” \n\nThis is somewhere in Hope?\n\n“Yeah.”\n\nWhat year did you first come here?\n\n“1994.”              \n\nTalk about the volume; you mentioned before about the volume of people who came through this facility.\n\n“Yes; about 40,000 a year.  They would get the necessary aide in terms of where they could get another job, where there was a farm where there was a need, and if cars would break down, where they could go to get it repaired.  If they were going to get a job, there was even a resource through another agency to be able to pay for their repair to get them to the farm there.  On the way back, there was no help as you were supposed to have…”\n\nThey can’t stop there on the way back?\n\n“No, they can stop; but this type of aide was mostly to be able to get to the work area.  Then of course, they make their money and they use it.”\n\n\nWhat time of year would they be coming down?\n\n“The camp was closed December and January; so, all the rest of the year.  You had people who had to prepare the areas, the ones who had to pick up the crop, and then there were ones who were involved in the packing; different times of the year were different ways.”\n\nTalk a little but about what they could do; they could only spend so many hours here and stuff like that.\n\n“Usually, it was established for 12 hours maximum and most only used it for about five hours.  They had all their family in one vehicle and that was going to have to put what they for the next six to eight months; that’s usually how it went.  Not necessarily would it be only one place; it could be that they get divided into another crop in that same kind of area there, so they would get the resources  for education for their children and the connections to where they were going to go.  They would get a sheet for the cot and it was not like a fancy motel or anything like that; they would have to pay.  There was a minimal amount of money required to put down.  I think it was something like $3.00-$9.00 for the room.”\n\nAre we talking about the area we are at here or was it the other area?\n\n“It was the other area, but the same circumstances came here.  The cost might have gone up a little bit or something to that extent.  They had community showers.  They had a washer and dryer. They’d have those barbeque areas like a picnic area for cooking.  Then you would see for example the family would come and the eldest daughter would say, “Ok dad, you go take a bath and so and so, you go do this and that as she prepared the meal.”  A very micro home; you know.”\n\nTalk a little about the family structure of the mother, the father, the children and the….\n\n“Grandmother, because you needed a babysitter.  So, usually grandmother would come in and health services would be needed because grandma forgot her insulin; forgot her medication.  Then on the way, they try to check the car and the radiator burns; stuff like that.  There was the migrant commission network that has also medical records from all of the migrant workers.  They would prepare a packet and if you saw one of the migrant workers and they were pregnant, had TB, diabetes, or something like that, they would then have that registered right in Austin, Texas.  Then if they went up to Michigan or New York, all they had to do was call that number and then the medical records were available; TB continuity of care; obstetric continuity of care; that’s how it would be able to be established.”\n\nDid y’all do chest clinics as well?\n\n“No; that was the health department.”\n\n\n\nYou had mentioned earlier that at one point the migrant worker portion of your work began to tail off; talk a little bit about that.\n\n“Yeah; unfortunate yeah.  The numbers started coming down and we couldn’t justify the cost of operation and then the doors were open to the community with emphasis to justify being in this location that we were serving an underserved area.  Word started getting out and we have people from El Dorado.  Still from the time that I was a resident, I had patients that were still coming in.  People from Louisiana, people from even Texas, lots of people from Texarkana, Mena, and people from Dequeen; I still have a lot of patients from Dequeen.  We also provided service at that time also as a civil surgeon for immigration services and that was very rewarding because I saw people from all countries.”\n\nWhat is a civil surgeon?\n\n“Ok, the homeland security requires a medical clearance and physical exam for the different requests these are residencies, citizenships, and each one will require a physical exam.  So, you apply for it and CABUN was the one who was doing this before I came; Dr. Floss and Dr. Sarnickey used to do these and once I came here and there were so many people coming that they needed a Spanish speaker to this facility; they had me included in that and that is the title they give you for the homeland security; INS.”\n\nHas there ever been any conflict since you are a community health center; any conflict between the presence of this clinic and you and the private medical community?\n\n“No, not that I know of because in fact when I came they looked at us as a resource.  But, no; not that I know of.  In fact, I do go or am part of the local hospital.  Dr. Young does the in-hospital care and work as a hospitalist and Dr. Goins; we are a resource for them also.”\n\nSo if you have a patient here who needs to be admitted from the clinic, do you sent them to the ER in Hope?\n\n“There or at St. Michaels; we also use them.  At the beginning, we used to use AHEC.  I am also; they have the residents come here.  At the beginning, it was known as their cultural medicine rotation; yeah.  So, now they come; before it used to be a whole month, that’s when we used to have a lot more.  Now, we have evolved; backgrounds and such.  It’s not as 100% Hispanic as it was before and 100% migratory workers; we now have a mixture of everybody and everything.”\n\nDo people from the local community of Hope come?\n\n“Anybody and everybody.”\n\n Do you like what you do?\n\n\n\n“Yes, I feel very rewarded in being able to help those, which I think I’m making a difference in their lives.  Especially when they don’t know why they were in a hospital and got operated or what happened.  They don’t know why they are taking their medications.  They just don’t understand the concept of refilling their bottles and those things.  But, that was a learning curve for me too.  Thanks to the migrant clinician network; I sat at their board and they had a wonderful program for medical personnel to learn Spanish and the program was to go to Mazatlan, Mexico, as I had never been to Mexico to begin with, and they asked me to go and see the program and how it was done.  They would have you go there and they would assign you a family who would be your host family; you would stay there.   You learn to speak and eat Spanish in that family and then in the morning, you would go to the University and they would give you structurized classes in English, but about how to word things in Spanish and mostly in the Mexican point of view; their cultural, the holistics, the homeopathic and that kind of stuff. In the afternoon, you would visit their different health care facilities.  You would have of course the health department, like we have here.  Then you have the hospitals that are out in the rural, very out with very minimal facilities.  You also have the hospitals for the elite; very well staffed.  Interesting the concepts of their immunizations, they are really strong on it; the health department, at least at Mazatlan that I was able to witness and I went with one of their nurses; they go door to door and ask for the papers of the child immunization and they tell them, “Ok, your baby needs this and this and that” and the next week or so they will come with a freezer and inject them right there and “ you are delayed on your pap and mammogram, you need to make that appointment go to the next one” to that extent. Another thing which was surprising was that they have these campaigns where the nonprofit organizations will get together and staff these massive immunization places; like the Lion’s Club and stuff like that.  They would also de-worm because parasite it very prevalent there; Albendazole for everybody.  So you learn that when mom comes here and says, “My baby needs to be de-wormed” they are like “What?” No, it is because that it costmary and usual; they can go to the pharmacy and get their medicine without a prescription and if they need something, they have to go to the doctor.  They don’t understand that here we have a bottle that says refill and you take that to the pharmacy and you don’t have to come back to me until three months.  The fact that you finished the bottle does not mean that you’re not diabetic anymore; you know that kind of concept to that element.  Over there, they also have clinics just for Malaria; they had clinics for leprosy; and of course they have clinics for tuberculosis, that was very known and they have the obstetrics and all that.  I had no idea that it was that common there and it opens you an awareness to be on the lookout.”                         \n\nIs there much difference between English spoken in Puerto Rico than in Mexico? \n\n“I imagine so.”\n\nDo you notice a difference in accent?\n\n\n“Oh the Spanish you mean; yes, yes, of course yes.”\n\nTalk a little bit about in Arkansas when you moved from one section of the state to another, we run into different illness patterns.  Did you see different illness patterns among the migrant worker?  Talk about that a bit.\n\n“Oh yes; yes.  I didn’t know anything about this until I started working here.  It all started with a patient that was in Tyson industry and had a seizure; adult onset seizure, full tonic, clonic blown and gets brought into the ER.  There he goes ahead in Hope and they can’t get him nothing then; Dilantin and Valium in the man and they are trying to do a CT; finally they get that CT done.  The radiologist reads it as multiple micro-hemorrhages of the brain as is.  Then he gets discharged with Dilantin, I believe it was.  I start researching and I can’t remember how I came across it, because I knew that that was not the issue there.  The thing is, I found out that it was a parasite; I think I asked for an over-read of it and the EEG was ok and it turns out that it was a cycsticerosis. So, I started on that investigation and there wasn’t much written about it, but I started finding different literatures.  I got them there; I think I still have the originals from when I started research on it.  Albendazole was the to go to drug at that time and there was another one, but eventually, I started noticing more cases; especially adult onset seizures and it was simple to drawl  the blood and you would find cycticerosis titers and that was the treatment of it.  Then you would have to get the clearance to make sure that there wasn’t a cyst near the optic nerve and that there wasn’t going to be an occlusion in any way of the conduct of the spinal fluid ventricle; that kind of stuff and coordinate because it was just one week of treatment.  Give them some steroids to reduce the inflammation of the brain; make sure of course the Dilantin, but give them Albendazole for the week and it was done.  You then have that taken care of and no seizures for a year with the Dilantin.  Incredible the outcome and the benefit.”            \n\nDid you see this frequently?\n\n“Yes; then I started coordinating and talking with UAMS about it.  I had a little girl who had a headache; she was very mature.  I think she was 7-10 years old; a very mature child.  She said, “I’ve got these headaches” and I asked is there anybody else, getting the history.  “Yes, I have a sister who has seizures.”  “Oh, Ok” so I go ahead and drawl the blood, because that is something that we would do here.  Drawl the blood and bingo; ok get the image now because we are talking about cost effectiveness right; yeah.”\n\nYou drawl the blood and then get the CT?\n\n“Yeah, because it was just a headache on a 7-10 year old.  Do you normally get a CT right off the bat; no.  You would say, “Check the eyes and stuff.”  But that was highly suggestive if you have the titers to get them confirmed.  That was interesting and to see the child get treated without any further….otherwise, they would go on and be treated for epilepsy.  Really, in your \n\n\nprofessional experiences, how many did you see; none.  I think I still have some films that I have saved for the residents and stuff like that; so yeah…really, really interesting.”\n\nAny unusual disease processes that you saw in Puerto Rico that you don’t see here?\n\n“Bilharzias; liver flukes and a lot more Cystocicercoma, Manzoni, and you also have danga, a fever that is more common there.  But the number one thing I think mostly was diabetes, very much in the Hispanic communities; especially from Mexico because of all those tortillas.  My goodness they eat a lot of tortillas.”        \n\n Your impression about obesity; were the migrant workers any more or less obsess than the average person in this county?\n\n“No, they are sweating it out.  They are working; most of them are healthy out there working heavily.  But, it’s the grandmother that stays at home that might be.  Later on; yeah, you have some.  But if you are talking about generalizing, these people work hard and sweat.”\n\nLet’s shift course a little bit and talk about your family and your family’s adaptation to your being a physician.  Talk about how you met your husband. \n\n”It turns out that when I graduated from my residency and I had accepted coming to work for the farm labor center, I was assigned a nurse of course and I asked the nurse that only had like one weekend to be able to relocate; I asked her if she could set me up with some relaters so that we could find a place to live and relocate there.  She said, “Oh yes; fine.”  She calls me back and says, “By the way, I have an invitation from my father in law to have lunch and he would like for you to join us.” I said, “Oh fine, wonderful.”  So, I go with my mother and when we get there, he was very, very, cordial and also from Puerto Rico; in fact, he was the only other Puerto Rican in this town.  It’s the very first day I come to Hope and I set foot there.  He has made; oh a wonderful cook, and he made an ethnical dish for us and when he serves the peach brandy at the end, his hand was like this….he was nervous and I thought “how cute, he’s shaking.”  He was so flattering and very intelligent and charming. He was retired already and worked as an assistant to the ambassador at the American Embassy in Italy; yes.  Then, he also worked for Horizon’s Investors and he was retired.   So when we said goodbye part of our culture is to embrace and that is something wonderful down here in the south; you guys hug too, so it’s right back at home.  So, he hugged me and it just felt like home and I said, “Oh my gosh; those arms felt so right.”  Later on, he tries to invite us to lunch while I’m working and when he invites us to lunch of course my secretary comes and then my nurse, who is his daughter in law, comes; so it’s always a trio coming in for lunch.  So, he asked to go out to get to know me better and I says, “Oh I’m sorry, I have to study for the board and I cannot do that.”  For me, I have always been the type that I have to submerge myself and so, I was not available for that.  Later on he tickles and says, “I have been waiting for her all my life; what’s six more months going to matter.”  So the very first time I set foot in this town, I met the love of my life.”\n\n\nWhat year was this?\n\n“1994; when I graduate, we got married in 1995.  We started dating three months before that.”\n\nI think you said you have three step children?\n\n“Yes; three stepsons and they are wonderful.  They were so happy to have me in the family and accepted me like one of their own.  Whenever they have a problem, they always come to me in terms of health issues.  Their mom is one of my patients and she has remarried.  Unfortunately, she has been a widow twice already and we’ve always been there for her; we’re very supportive and we have holidays all together.  It is very positive and enriching.  That two helps me to help  my patients because most important even if the marriage doesn’t work out is to support each other and to realize that you’re not divorcing the children and that you will always be attached to that other person for the rest of your life.  So, you’ve got to establish that harmony.”                 \n\nDo you have any grandchildren?\n\n“Six of them; four of them saw me when they were born and so, that is really cool; it is cool.”\n\nWhat is your husband’s name?\n\n“Jose Covas Castaneda.”\n\nHow did they adapt to you being a physician?\n\n“Well most of them were already married and moved on; in this town right now, none of them are here; they have all moved on.  So, it’s the old man and I.” \n\nAre you involved in the community?\n\n“Yes, very much in my church and to help out in benefits.  My mom always, I guess it comes from my grandmother, help others; mostly in private.  That has always been something I grew up with, even in New York.”\n\nIs your mother still alive?\n\n“No.”\n\nWhen did she pass?\n\n“2004.”  \n\nYou and I talked before we started this and I think you used a curse word to describe electronic medical records.  I won’t ask you to repeat that for this interview, but let’s talk about medical records and technology in medicine.  How has it changed?  You have now been \n\n\nHere in practice for 20+ years; how has it changed what you do when walk into the exam room?\n\n“Oh yeah, big time; since 1985 when I started, so many things have changed.  There are some advantages of course, but also that of frustrations.  Before you could see so many more patients and you had the paper chart and all I had to do was flip a page and the first side of that page had their past medical history, their current medications, all their surgeries and I even had preventive health plans as well as if they had a specialist, what was their telephone number.  One glance, one page; done.  You needed to know what was the last lab, take a tab and there it is.  Write the note; now that is the disadvantage.  The note was two lines there and the diagnosis and the medication; honestly.  Then check box later on; we did the check box thing to support your diagnosis kind of stuff.  Now of course, the documentation is all this computer; writing, typing; a lot more typing…click this and drag this into the other and yeah; that note looks gorgeous with all that, but do you know how much time it took you to get the past medical history plus when they come in, you have to put all that information that could have been written down real quick; it’s got a box for this and a box for that, do this, come here, go there.  Oh, they got past medical history records that were scanned in, but you got to look back and find it and everybody scans it in different places depending on who scanned it in.  So, you got to look here and there and do you know how long it is and you’re still waiting and your patient came from something simple.  But, it is the first time and you’re trying to figure out where everything goes; uh huh.  Of course, then community health center, you have all the UDS and you have all those codes and all that documentation that has to be put in, because that’s where the grant money comes in and it has to be accountable.  What before used to be so simple and we could see more patients; that report now.  To have that repore with the patients, I have my computer and I have that little cart; because I put in on that cart and I drag that into each room with the patients.  That cart has that blue folder there; information on diet and stuff like that.  I have the peak flow there and I’ve got the wheel for the BMI, even though the VMI comes there, I’ve got the wheel that will tell them how much you’ve got to weigh or loss and what’s our ideal and what we are going for.  I have all this other stuff, but I’m dragging it in now.  So, that is very frustrating in the sense that I’m wasting a lot more life time having to put all this information in and honestly the pressure that you have to see so many patients a day is on you.  Then, my personal experience is if you don’t do as much as you can right there, it is going to be so much harder to take it back home and you are cutting off time with your spouse; your family quality time.  So, that quality of medical records has cut off quality of life; that’s my drawback.”\n\nDo your patients like electronic records; do you ever hear anything back from them?\n\n“No; well of course if I do a physical and they have to take it somewhere, I finish it there and it is really cool that I can print it off.  “Here you go; done today” and it’s prettier and cleaner than \n\n\nwhat we have there; that is a plus there.  I guess we’re in the growing pains, but boy it sure is talking me a long time to get this pain away.”\n\nHave you found medicine to be gratifying?\n\n“Oh yes; especially when the patient comes back and says “thank you.” You can see that they finally understood.  When you hear, my husband says that he was in Wal-Mart and he heard some lady say, “Oh, I like going to Dr. Covas because she explains what is going on” because I understand what is happening to them.”\n\nHow long have you been in practice total now; not just in Hope?\n\n“I graduated in 1985.”\n\nYou’ve been 31 years.              \n\n “I feel old.”\n\nWell, we are older than you are.           \n\nSo how long will you keep practicing medicine; have you thought about it?\n\n“I always say, “Well, what am I going to do?”  Yeah, I would image at 65; I’m getting to this point that I have felt the calling all these years, but things have changed.  We are not already a migrant farm worker.  Lots of things have changed and I’m asking for the new calling.  I think that it’s close to changing; I don’t know where it’s going to go, but yeah.” \n\nAre you still in good health?\n\n“Yes, yes, yes; I don’t know maybe missionary work or something like that.”\n\nIf you had young children at home or your grandchildren; would you encourage them to go into medicine?\n\n”It all depends on them.  You have to have a heart for it.  You have to have patience.  You have to be able to be very patient elemental many times, but above all, responsible for that continuity of care.  Sometimes, it’s hard because you are not God and there are things we can’t change.  So many times, it’s frustrating because you know that things could be different and the patients have to take responsibility for their illnesses too.  At the beginning, I used to get so upset, but you now I learned.  What I do now is say, “OK, so you didn’t bring your medicine and you haven’t been checking your blood sugars, you haven’t brought back your log like I asked you to and you didn’t write down what you’re eating.  So, you came here to visit me; wonderful.  What do we talk about then? Maybe next time, we can do something to improve your health.”  Once I did that, hat was the biggest relief ever.  Before, I used to get so upset and into their faces and stuff like…no, no, no…so now I think “ok, you are paying to just visit and thank you so much for \n\n\ncoming to see me.”  That first of all was the number one thing; realize that they are actually waiting out there and they are paying to see you.  I don’t need to be upset with them, I need to appreciate that they came.  Then I tell them, “You would make better use of your money and of my resources because you came for what I am able to help you and teach you and hopefully heal you if you do X, Y, and Z.  But if all you want to do is talk to me, that’s good too because that is part of health; psychiatric heath, and I thank you for coming.”  Once you realize that, you feel better; you don’t feel as frustrated.  Because then, it is their decision that is made there and you know, next time they do bring the stuff that you asked of them.  When before, I used to get all in their faces each time and it was a battle and they used to say, “Oh, I go over there and she gets all upset about me.”  Now, I don’t get upset and they are coming through.”        \n\nWhen did you learn that?\n\n“Oh, maybe about 2-3 years ago.”\n\nEvery day.\n\n“Every day is a challenge, right?  Yes, you have different challenges, but most of the time that’s the thing.”\n\nWhat did you think your life would be like in medicine when you went to medical school?\n\n“Are you asking that when I went into medical school did I think it would be any different than that?”\n\nWell, I mean did you think computers would take such as big role?\n\n“I didn’t even know computers was coming down the line; no.  I’m sorry, no.”\n\nLooking ahead now, what do you think of future of medicine will be?\n\n“Well, hopefully more efficient and better programs are developed.  I hope that things will improve.  I think the bottom line here was that there wasn’t a program that was established so that all institutions could communicate and that it would be individually tailored to your practice, but you have one giant communication.  There has been to avoid monopoly, too many out there and it seems like each one is developing their own; I think that is part of the problem.”\n\nDo you miss OB?\n\n“Yes, I did very much and I still do.  It’s that romantic thing of feeling a life coming in and you’re a part of it feeling like that’s my baby too; yeah.”\n\nDo you have anything that you would like to add that we haven’t asked you about already?\n\n“Well you had told me what I would advise my grandchildren.”\n\n\nWe’ll get to that; that is my last question.\n\n“That’s it probably.  For someone who wanted to go into medicine; I guess the number one thing is to have a heart in what you do. I think what I have learned and what I would like others to know is to realize that that patient is paying for your services and you should feel honored in doing that.  I think that that has been the turning point within my life, at this time, to look at the change in practice that has gone on to realize that.  It’s a service; it really is a service and it’s a privilege.  People are opening their most vulnerable time; because when you don’t feel ill, you feel invulnerable and mortal.  You’ve got that privilege that they are sharing with you and asking you for their help.”\n\nWell, you’ve answered my last question without me even asking it.  Thank you Dr. Covas; I appreciate it very much.  It was a wonderful interview.\n\nI still want to ask you, you’ve answered it partially; but tell your grandchildren or your great, grandchildren what you would like them to know about life and about medicine?\n\n“Not only them, but the whole minority groups; you have to embrace who you are and know your roots; be proud of them.  Be thankful that you are here and whatever you decide to do in life, ask for guidance because this is a road just like parenthood; there is no instruction book.   You have virtues and talents and only the one above really knows them.  Ask for his guidance and if you do that, you will go on the biggest widest ride and just enjoy it.  Enjoy it; enjoy life.”     \n\nThat’s excellent.","format":"text/plain"},"target":"https://centerforthehistoryoffamilymedicine.aviaryplatform.com/collections/2312/collection_resources/161634/file/293473#t=0.0,6409.36963"}]}]}]}