Liz Narration: Max Cuevas childhood was like that of many Latinos in this country…
Max Cuevas: working in the fields, along with my mom and dad, and at one point there were nine of us.
Liz Narration: His family, and all the Mexican families they knew in their little town of Lindsay California, made livings doing backbreaking work in the fields.
[PERCUSSIVE MUSIC BEGINS]
Lindsay is in the center of the state – and most of its economy relies on agriculture – especially citrus fruits
Max Cuevas: You’re carrying about a 70 pound sack that you’re filling with either oranges or, or lemons and you’re climbing up and down a ladder. Once it’s filled, then you go dump it, and then the process starts again.
Liz Narration: During the weekdays Max and his siblings would be in school, then once the weekend rolled around, they’d be working with the family. The same went for vacations.
Max Cuevas: Any holiday we’d be out there with them. So during the Christmas break, we’d be out there. in the fields with my mom and dad
Liz Narration: At home in Lindsay, they’d pick oranges and lemons through the colder months. Then, as soon as summer break started, the whole family would pack their car and drive up to San Jose, living in tent camps picking cherries, apricots and pears, until August. They’d then drive south to Fresno for the grape season before coming back to Lindsay to catch the start of school and the next orange season.
Max Cuevas: That was the cycle for us. Year in, year out. and we had pretty, uh, nice, warm memories about that experience. Somehow, my mom and dad made it fun.
Liz Narration: Though the work was tough, they coped with the hard times like so many of us do, with humor.
[MUSIC FADES]
Liz Narration: Until they had to face a family tragedy that no one could ever have prepared them for. One of Max’s younger brothers got very sick. He was prescribed penicillin to get better but had a severe allergic reaction. Just a few days after taking it, he died.
Max Cuevas: Seeing the hurt and the crying, it was inconsolable. I could see it in my mom and dad, my grandmother, my other brothers and sisters, and I thought, maybe if I can become a physician, maybe it’ll make a difference.
[PENSIVE MUSIC BEGINS]
Liz Narration: His motivation: to change the way care is delivered to people in his community…
There are more than 62 million Latinos in the US, according to the most recent Census. In states like California, where there’s a large share of the country’s Latino population, over a quarter speak Spanish at home. There’s a shortage of doctors, though, who can serve this population well – who understand the language – and their needs.
For this episode of In Confianza, we collaborated with WHYY’s Health & Science show “The Pulse” to tell the story of an out-of-the-box idea that would give healthcare access, in Spanish, to thousands of Latino farm workers, and show how the need to be understood, seen, and heard, is at the center of healthcare. I’m Liz Rebecca Alarcón. This is In Confianza with Pulso.
[PENSIVE MUSIC ENDS]
Liz Narration: When Max first announced that he was going to become a doctor, no one really believed that this small-town Mexican kid could actually succeed.
Max Cuevas: I let classmates and the school teachers know and they were sort of like, well, that’s nice to have dreams, but don’t worry if your dreams aren’t fulfilled. I guess politely trying to tell me, yeah, right.
Liz Narration: But the more he dreamed of becoming a doctor, the more he started to become aware of all the health issues that people around him were facing. One day, in a tent camp up in San Jose, he overheard a woman talking about her sickness
She was suffering from pain in her mid-section, and brought her daughter along to the doctor to translate.
Max Cuevas: The mom takes her young daughter with her to translate because the mom couldn’t speak English. and so the non-Hispanic white physician, he says, what can I do for you?
[STRING BASED MUSIC BEGINS]
Liz Narration: She tells her daughter she has “dolor del bazo” pain in her spleen. The daughter couldn’t quite translate that, so she tells the doctor, well my mom,, she has a dollar in the glass. The girl didn’t know the word for spleen in Spanish, “Bazo,” and heard “Vaso,” which means glass, and so pain in the spleen, dolor del bazo, became dollar del “vaso.” A dollar in the glass. And so the doctor was lost, and couldn’t help this mother.
Just a few towns away another young Mexican American boy was having a similar experience.
Arnoldo Torres: I would go with my grandmother to translate to the doctor or my grandfather. Those were very personal experiences
Liz Narration: His name was Arnoldo Torres, and neither he nor Max knew it at the time, but their experiences would bring them together in a surprising, and meaningful way. Arnoldo was living in Sacramento. His Mexican American family also made their living in the fields, and when he turned 10…
Arnoldo Torres: My grandfather told me that I was of the age in which I had to do la cosa cristiana, the Christian thing. And I asked him, Papi, what is that? And he says, you have to contribute to the wellbeing of the family. You have to work.
Liz Narration: So he worked. Just like Max, Arnoldo spent countless hours as a child and teenager picking fruit in the fields until he was old enough to go out on his own. Arnoldo had his mind set on going to college – and after getting a bachelor’s degree in political science he went to Washington DC to pursue a master’s degree in public policy. It was a whole new world for him…
[STRING BASED MUSIC ENDS]
Arnoldo Torres: The Capitol is so beautiful at night with the way the lights are shined. And I remember telling myself, “could you have imagined that you, the son and the grandson of farm workers right now, In most instances would be working in the fields as opposed to walking on the grounds of the United States Capitol?” It was truly an amazing feeling to never forget your roots, to see what was possible.
Liz Narration: His goal was to work in politics and policy so he could help change things for those back home, but the path he chose was not easy. Pursuing a career in public policy as a son of Mexican farmworkers came with serious challenges.
Arnoldo Torres: You were always having to prove yourself. Always. It never stops. You get tired. You would know some of the staff people would say, “Oh, here comes the Mexican. He’s going to talk to us about Mexican issues.”
Liz Narration: Back in California, Max Cuevas was in medical school at UC San Francisco facing similar issues…
Max Cuevas: You took exams like everybody else and you got in based on your academic credential. Yeah, so why is it that students and faculty alike can tell you you don’t belong there? Is it because of your name, a Latino name? Is it because of your color, You know, what, what is it?
Liz Narration: Max & Arnoldo were up against an uphill battle in their respective fields, but they never backed down. One thing their upbringing instilled in them was the desire to help, to support their communities. After getting his master’s degree in 1977, Arnoldo started working in DC with The League of United Latin American Citizens — LULAC. He worked on immigration reform, civil rights, housing, all kinds of issues. In 1985, he decided to come back to California to advise local health clinics.
Meanwhile, Max, who had completed his residency in OBGYN at UCLA & Kern Medical Center, had a choice to make. He could choose anywhere in the country to practice but he decided to stay and do what he always planned – serve his community…
[PULSE-Y MUSIC BEGINS]
So in 1987, Max, now Doctor Max Cuevas, became the chief medical officer at a little health clinic, La ClĂnica de Salud del Valle de Salinas, or CSVS, in Salinas California. His days would now be spent serving a farmworker community just like the one he grew up in.
The Salinas Valley, about an hour’s drive south from San Francisco, is known as the salad bowl of the world. It produces a huge amount of the fruits and vegetables we eat, and because of this it has one of the highest populations of farmworkers in the United States. It turned out that Arnoldo was advising the CSVS Clinic…and this is how Max and Arnoldo FINALLY met!
Arnoldo Torres: He and I were drawn to each other because We both worked in the fields. There was a very special bond. There’s a solidarity between us because of these experiences as children growing up in the same kind of environment.
Liz Narration: And Max felt the same.
Max Cuevas: When we found out that we were both from farm worker backgrounds, it provided another reason for connecting.
Liz Narration: They knew each other in a way that others couldn’t, And they both shared the same purpose of helping people in their communities. In 1993 something happened that would bring the clinic where Max worked to a breaking point and change these communities forever: it was NAFTA, the North American Free Trade Agreement.
[PULSE-Y MUSIC ENDS]
[Press Conference audio of NAFTA signing fades up]
BILL CLINTON: Thank you very much. Just a few minutes ago, the House of Representatives voted to approve the North American Free Trade Agreement. NAFTA will expand our exports, create new jobs, and help us reassert America’s leadership in the global economy. This agreement is in the deep…
[Press Conference audio of NAFTA signing fades down]
Liz Narration: NAFTA removed trade tariffs between the US and Mexico, which opened the door for heavily subsidized US Agriculture companies to export their crops south of the border way below cost in the Mexican market. The result was devastating. Many local Mexican farmers lost virtually all of their income.
Arnoldo Torres: They panicked, they had to find employment, they started going to the big cities in Mexico. There weren’t jobs there. So they turned to the United States and we had a major inflow of undocumented workers. Our health centers, uh, were completely inundated.
Liz Narration: The CSVS Clinic, where Max worked, was totally overwhelmed. There were more and more farm workers coming from Mexico speaking Spanish and indigenous languages, but not enough doctors who knew the languages or the culture.
Max Cuevas: Those communities I think are hardest hit. By the inability of physicians working there to be able to communicate and to understand also the culture. How it is that people perceive their illness, their disease.
Liz Narration: Patients weren’t able to understand the severity of their illnesses or how to treat them, and in many cases, this was leading to patients not getting any medical care at all. Max saw firsthand what was happening to patients who weren’t able to receive treatment for illnesses like diabetes.
Max Cuevas: Blood vessels are shutting down, scarring up, you know, blocking off different body parts begin to malfunction to the point where they stop functioning. people wind up losing kidneys, going on dialysis, going blind feet, toes getting cut off.
Arnoldo Torres: You must have trust with the doctor. when you can’t communicate, you don’t have the foundational element for trust.
Liz Narration: So Arnoldo & Max decided they had to do something. The two men had different professional experiences – but complementary skills. Arnoldo knew how to handle policies and politics, while Max knew the medical side. Together they set off on a mission to find more Spanish speaking doctors. First they tried to convince the California medical school system to simply add culture and language programs, which makes sense considering that Latinos made up 40% of the population in California at the time. But, they hit a wall.
Arnoldo Torres: We could not get those people, at all to make any changes. They refused to provide any classes in culture, any classes in language. We tried everything we could for at least, uh, two years with the UC system, and after, uh, the first year, we recognized that we weren’t, they weren’t going to budge.
Liz Narration: With the problem growing even worse, Arnoldo came up with a wild plan.
[INTROSPECTIVE MUSIC FADES IN]
Arnoldo Torres: I came up with the idea, uh, that the only avenue that we had was to go outside and see if we could bring doctors in.
Max Cuevas: And I said, “what do we need to do? Who do we need to talk to?” He was excited. I was hell excited, uh, myself, thinking, “wow, we can make this thing happen.”
Liz Narration: Their brilliant idea was to create a program that would allow Mexican doctors to work in the US for 3 years. To go south of the border and recruit doctors, they would need support from the U.S. & Mexican Governments, California’s Medical Board & association, Mexican Universities, & The California Medical school system which had already been so difficult to breach. It seemed impossible. But without any other options, they pressed ahead
Max Cuevas: We realized and understood It’s going to be a hard fight, but we’re in it to win.
Arnoldo Torres: I knew it was going to be a formidable initiative, Because of who we had against us, which was everybody, I mean, everybody.
Liz Narration: But – they weren’t ready to give up just yet. More, when we come back.
[INTROSPECTIVE MUSIC FADES OUT]
Liz Narration: Max & Arnoldo knew their idea to recruit doctors from Mexico would be a tough sell, but they didn’t realize just how tough.
Max Cuevas: I was surprised by Latino physicians and Latino physician groups that were against the program. In fact, one of them, um, dubbed the program a Mexican Bracero Doctor Program.
[INTROSPECTIVE MUSIC FADES IN]
Liz Narration: The Bracero program was now an infamous initiative that brought Mexican farmworkers to the U.S., to support agriculture during and after the 2nd world war. Many Braceros were cheated and abused by employers and exposed to harmful pesticides…, which gave the program a terrible name.
This of course was nothing like that. But still, people had all kinds of pushback. Some argued that the Mexican doctors were substandard compared to American doctors
Arnoldo Torres: Clearly, they did not understand how insulting and offensive that concept and that statement was, but that is the argument they gave.
Liz Narration: Others argued that this program would be replacing or taking the jobs of US-Latino Doctors, that it was a form of competition.
Max Cuevas: There’s so much need in healthcare out there, especially in low income communities. You can bring a lot of physicians and you’re still not gonna scratch the surface.
[INTROSPECTIVE MUSIC FADES OUT]
Liz Narration: And others just didn’t like the idea itself. But after 3 long years of meetings, of advocating, and talking to hundreds of people. They succeeded to get it on a bill in the California legislature. And guess what? It PASSED! Bill AB1045 was signed into law by then Governor Gray Davis in September of 2002.
Liz Narration: But this was just the beginning
Max Cuevas: The easy part is done.
Liz Narration: Because there were so many fears about the Mexican doctors not being up to par, part of the Bill specified that they would do an orientation program with the UC school system that would help the new doctors integrate into the American medical system. The next big hurdle was to get the UC School system to follow through.
Max Cuevas: We went to them thinking that they’re going to embrace the program. And then when they came out and told us, flat out, in our face. that they wanted nothing to do with this program. That, to begin with, doctors from Mexico are inferior.
Arnoldo Torres: We could not implement it because there was no UC medical school that wanted to cooperate. It just languished. Oh, the anger was the anger, the frustration, all the suffering that our population is going through because they can’t access medical care.
Liz Narration: We reached out to UC Medical School to ask about this. They told us in an email that quote: “The University of California did not take a position opposing AB 1045” end quote. They added that they strongly support the goals of the legislation. Max says there was no support when they first tried to launch the program – which was a big blow, but he tried to stay optimistic…
Max Cuevas: I didn’t think it was over. I, I just thought, let’s take a deep breath, you know, let’s go to halftime. Let’s, uh, regroup, change our game plan, and let’s go out and give them hell.
[SLOW, PENSIVE MUSIC BEGINS]
Liz Narration: By this point, they were exhausted, and their careers were already demanding enough. The program was put on hold, months turned into years and time went on. But the farmworkers still worked, they still got sick, they still couldn’t understand doctors, they still suffered. The clinics tried to make it work with interpreters, but there were nowhere near enough. And even when they did find one, the nuances of doctor-patient conversations would often get lost in translation, it just didn’t work. As time went on, more and more migrant workers came to harvest and pack the food that feeds this country, and the lack of culturally competent doctors grew even more dire. By 2015, Max’s clinic in Salinas was completely overwhelmed, so he picked up the phone and made a call to his old friend
Arnoldo Torres: He called me up and he said, “Is this project still accessible? Can we still implement it?” And I said, “yes, we can.” He goes, “well, let’s, uh, let’s try it again.”
[SLOW, PENSIVE MUSIC FADES OUT]
Liz Narration: They decided to give their effort to bring Mexican doctors to the US, one more shot. But this time, they had a new idea to get the physicians evaluated: They decided to try and work with a local hospital, Natividad Medical Center, right next door in Salinas.
Arnoldo Torres: We went to them and said, would you be willing to sponsor the orientation program?
Liz Narration: it took lots of meetings, some negotiating, but in the end…
Arnoldo Torres: We were absolutely so pleased that it was unanimous and the interest by the board in supporting this was beyond anything that we could have expected.
[VIBRAPHONE MUSIC BEGINS]
Liz Narration: So in early august 2021 the first of 30 Mexican Doctors got on a plane and flew to California.
Arnoldo Torres: August the 9th was the first day the doctor began to see patients.
Liz Narration: Then another 10 came in March, 10 more in September, 7 more in January… little by little doctors started to trickle in.
[MEDICAL APPOINTMENT AUDIO FADES UP]
Dr. Moreno (In Spanish): It’s a pleasure to greet you again. Well, my dear Aguita, for today, we already have a 33 week pregnancy. Well, thank God, there we go, moving forward, right? Day by day.
[MEDICAL APPOINTMENT AUDIO FADES UNDER NARRATION]
Liz Narration: This is doctor Armando Moreno, an OBGYN from Mexico City. Today he is seeing a patient for a checkup at the clinic de Salud’s Sanborn location.. She’s 33 weeks pregnant. He chats comfortably with her, and looks at the her kindly, as he asks what the name of the baby will be
Dr. Moreno (In Spanish): Yes What is her name?
Patient (In Spanish): Her name is Isabel.
Dr. Moreno (In Spanish): Isabel, ah, very good. Well let’s talk about how Isabella is. Our dear Isabella, for this ultrasound, weighed 1850 grams, which is very good.
[MEDICAL APPOINTMENT AUDIO FADES UNDER NARRATION]
Liz Narration: All the news is good, Isabella Weights 1,850 grams, she’s healthy, and kicking. He puts an ultrasound to her belly to listen to the heart beat
[AUDIO OF ULTRASOUND]
Dr Moreno: My first day here, I was really scared. To be honest, I was really scared.
[VIBRAPHONE MUSIC FADES OUT]
Liz Narration: in 2016, he got a call from his supervisor in Mexico City telling him about a program.
Dr Moreno: He told me, “Hey, I have this invitation for you. I met these guys, Arnoldo, Dr. Cuevas, and, and I think this work fits with you.”
Liz Narration: His whole body lit up with excitement.
Dr Moreno: Sometimes in our lifetime we have these moments when you feel like this burning sensation inside your heart. When you know that, that something’s gonna change.
Liz Narration: And this was one of those moments.
Dr Moreno: I said, “I can’t miss this opportunity. I need to be part of it.”
Liz Narration: He applied, then waited, six whole years, until finally in July 2022, he got the news. He and his wife quit their jobs, moved out of their house, and boarded a plane to San Francisco with his two cats to start their new adventure.
Dr Moreno: You enter to the, to the room, of course, the patient is waiting for you and you enter. When you say these words in Spanish, you can notice in the patient’s eyes, this small, uh, smile. And You know, you know, that the patient is comfortable. You know that the patient is happy.
Liz Narration:…as comfortable as one can be at the doctors office.
Dr Moreno: You build this bridge between you and your patient. There’s a lot of unconscious background mutual understanding like this empathy. There’s like, uh, sublime, subconscious, uh, communication between people from the same culture.
Liz Narration: And often, the patients are so grateful to doctor Armando, that they bring him gifts!
Dr Moreno: Some patients just say thank you. Some other patients usually bring us food, cakes, pupusas, wine. At least a couple of times every day, I, I hear, “doctor, thank you for explaining me my disease. Thank you for taking the time of, of let me know what I have.”
Patient Blanca: SĂ. SĂ, si se sientes estrĂ©s porque te hablan y no sabes quĂ© contestar, pues no entiendes.
Liz Narration: This is Blanca, one of Dr. Armando’s patients at the clinic
Patient Blanca [In Spanish]: Yes, you feel stressed because they talk to you and you don’t know what to answer, because you don’t understand. And here, the truth is, where do you go, simply to make appointments. It seemed very difficult for me at first, but no, now here I feel like a fish in water.
Liz Narration: Blanca is saying how in the past it’s been so stressful for her to go to doctors. That she doesn’t understand what the doctors are saying or how she should respond, even making the appointment is difficult. But now she feels so comfortable here at the clinic.
Patient Blanca [IN SPANISH]: Right now, it’s almost like my psychologist. And it gives you that confidence too.
Liz Narration: Blanca has such a strong level of trust with Armando that she feels almost like he’s her psychologist.
Dr Moreno: People here, they, most of them have, uh, really difficult experiences in, in their lives, in their, in their, their past.
Liz Narration: Often we think of medical care mostly as a physical practice. But for the doctors at the clinic, they’ve created such a level of trust that their patients have been opening up about so much more than just physical ailments.
Dr Moreno: I’ve, I’ve heard terrible, terrible stories about crossing the border, crossing the border. Crossing the Guatemala Mexico border. I mean, people struggle so much to be here.
Liz Narration: As an OBGYN, Armando sees many, many women who have been sexually assaulted. Teenagers tell stories of being separated from their parents. Women and men opening up about abuse, depression, & anxiety in their lives.
Dr Moreno: I think that it’s this opportunity we have to try to help them to open their hearts and to speak openly about it. This is the first step for healing.
[PENSIVE MUSIC FADES IN]
Max Cuevas: A lot of those patients now say, for the first time, “I understand what the hell is going on with my illness.” And then they ask me, “why did the doctors not tell us that before?” And I tell them, “well, you probably didn’t understand.”
Liz Narration: Today there are 30 Doctors in the program, each of them will serve for 3 years and be able to help hundreds of patients before returning back to Mexico. The goal is to have even more doctors, dentists, and psychiatrists take part in the program in the coming years. An updated version of the bill aims to have over 200 doctors by 2036. But it’s important to note that while AB1045 is making a huge impact in people’s lives, the scope of the problem is too big for one program to handle. Here’s Arnoldo:
Arnoldo Torres: It’s a band aid. It was never intended to be the answer. It was intended to provide time for the UC system to take on greater responsibility.
Liz Narration: This program can’t fix everything, but for Max , for Arnoldo, and all the Mexican doctors, there is a victory in every single visit where a person who felt alone, can see that they have someone on their side.
Dr Moreno: We have medical science, but we also have to take care about What they think, what they believe, what they fear. We need to take care of the human part.
Liz Narration: Health isn’t only about medicine, or treatments. It doesn’t just mean that one’s body is free from pain or injury, it’s also the need to be seen, to be, heard, and as these Mexican doctors are learning, it’s the need to be understood that beats at the heart of healthcare.
[PENSIVE MUSIC FADES OUT]
[THEME MUSIC FADES IN]
Liz Narration: This story was made in collaboration with WHYY’s health and science show, The Pulse, and supported by The Commonwealth Fund.
It was reported & produced by Charlie Garcia. Story Editing & Production Support from Maiken Scott & Alan Jinch. Sound Design & Mixing by Charlie Garcia. Additional field reporting from Jackie Noack, and additional audio editing from Julian Blackmore. Our Supervising Producer is Mark Pagán. I’m your host, Liz Rebecca Alarcón.
Special thanks go to Erick Lopez, Mayra Pantoja, and the staff at Clinica de Salud del Valle de Salinas.
You can subscribe to In Confianza wherever you get your podcasts and if you like what you heard please leave us a review on Apple Podcasts and tell a friend to give us a listen.
We’ll be back next week with another episode. Until then, we hope you find the right time and space for your own conversations, in confianza.
